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Item No.:
01
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Site:
Medical-AGE Reports
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Violation:
The AGE report submitted for the voyage from 2/21/24 to 2/26/24, included the actual number of passengers onboard at the time of the submission and not the number of passengers at embarkation.
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Recommendation:
Ensure the AGE report contains the following: (8) total number of passengers and crew members on the cruise at the begining of the voyage.
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Item No.:
01
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Site:
Medical-24 Hour Report
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Violation:
The 24 hour AGE report for voyage 1540 (1/2-1/8/24) included 2 passengers meeting the definition of a reportable case, however, in the 'Underlying Illness' column in the acute gastroenteritis (AGE)log for one of the cases and in documented emails to housekeeping it stated this individual was not an AGE case. The email to housekeeping was dated 1/4/2024 and the 24 hour report was submitted on the evening of 1/6/2024. Staff stated they were unable to deselect the reportable column in the ship's medical database after it was later concluded that the individual had underlying medical conditions and was not a case.
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Recommendation:
Ensure the AGE report contains the following: (1) name of the vessel; (2) port of embarkation; (3) date of embarkation; (4) port of disembarkation; (5) date of disembarkation; (6) total numbers of reportable cases of AGE among passengers, including those who have disembarked because of illness?even if the number is 0 (zero reporting); (7) total numbers of reportable cases of AGE among crew members, including those who have disembarked because of illness?even if the number is 0 (zero reporting); and (8) total number of passengers and crew members on the cruise.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis Log - Underlying Illness
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Violation:
The underlying illness columns for all voyages dating back through December 2023 were left blank except for a few entries each voyage.
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Recommendation:
Ensure the AGE surveillance log includes a header containing the following information about the voyage: (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? or similar wording.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
The AGE log for voyage 1540 (1/2-1/8/24) identified a passenger as a reportable case in the 'Reportable' column, however, in the 'Underlying Illness' column of the log and in documented emails to the housekeeping team it stated this individual was not an AGE case and was being treated for possible appendicitis. According to staff, the medical team was unable to deselect the reportable column in the ship's medical database and AGE log after it was later concluded that the individual had underlying conditions and was not a case.
Furthermore, it was unclear if the illness onset time and reporting to medical time in the AGE log were correct for this patient as the time in documented emails from the medical team to housekeeping did not match. Specifically, emails indicated symptoms began at 1115 and the time reported to medical was at 1615 and the AGE log indicated an illness onset and report to medical at 1852.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]). Ensure the AGE surveillance log includes a header containing the following information about the voyage: (1) Vessel name; (2) Voyage number; (3) Date from; (4) Date to; (5) Total number of passengers; (6) Reportable total number of passengers ill; (7) Total number of crew; (8) Reportable total number of crew ill. Total number of passengers and total number of crew must be the totals at the beginning of the voyage (i.e., totals on ?date from?). Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Patient ID; (2) Date of the first medical visit or report to staff of illness; (3) time of the first medical visit or report to staff of illness; (4) person's last name; (5) person's first name; (6) person's age; (7) person's sex; (8) designation as passenger or crew member; (9) cabin number; (10) crew member position or job on the vessel, if applicable; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24 hour period; (b) bloody stools (yes/no); (c) number of episodes of vomiting in a 24 hour period; (d) fever (yes/no); (e) abdominal cramps (yes/no); (f) headaches (yes/no); (g) myalgia (yes/no); (14) date of last symptom; (15) time of last symptom; (16) entry (yes/no) for whether a specimen was requested; (17) entry (yes/no) for whether a specimen was received; (18) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (19) entry (yes/no) for whether this was a reportable case; (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? or similar wording.
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Item No.:
03
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Site:
Potable Water-Production Records
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Violation:
Potable water production records for the following dates, 1/19/24, 1/11/24, and 11/26/24 indicated halogen residual levels dropped below 2.0ppm for approximately 30 minutes once on each date and no notations were provided.
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Recommendation:
Continuously halogenate potable water to at least 2.0 mg/L (ppm) free residual halogen at the time of bunkering or production with an automatic halogenation device that is controlled by a flow meter and adjust the pH so it does not exceed 7.8. Ensure the amount of halogen injected during bunkering or production is controlled by a flow meter or a free halogen analyzer.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Log
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Violation:
The listed reduced pressure zone assemblies for the RO Plant #1 and #2 listed the incorrect make and models. This was corrected.
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Recommendation:
Ensure the cross-connection control program includes at a minimum: a complete listing of cross-connections and the backflow prevention method or device for each, so there is a match to the plumbing system component and location. Include air gaps on the listing. Ensure a schedule for inspection frequency is set. Maintain a log documenting the inspection and maintenance in written or electronic form, and ensure it is available for review during inspections.
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Item No.:
11
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Site:
Medical-Late Report
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Violation:
A food worker who experienced acute gastroenteritis (AGE) symptoms at 0400 on 1/4/24 did not report to medical until 0915 later that day. Records indicated the crew member did not work during this time nor did they dine in the crew mess. Medical staff stated disciplinary action was taken. Additionally, a nonfood worker experienced AGE symptoms beginning at 0330 on 12/31 and did not report to medical until 0800 later that day. This occurred during a voyage where >2% of the passenger population were reportable AGE cases. This crew member did not work or leave the cabin between symptoms and reporting to medical.
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Recommendation:
When food employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 48 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document date and time of last symptom and clearance to return to work. When nonfood employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 24 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document the date and time of last symptom and clearance to return to work. Ensure the food employee's supervisor or person in charge conducts an assessment of food prepared or served by the food employee while symptomatic and take appropriate corrective actions. Document corrective actions taken as a result of the assessment. Maintain records for 1 year and make them available for review during inspections. Review [when possible] any AGE cases among passengers or crew reported after the ill food employee?s symptom onset for epidemiologic link/connection. Appropriate corrective actions could include discarding ready-to eat food, thoroughly cooking raw food, and disinfecting the food area and equipment.
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Item No.:
19
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Site:
Other-Bridge - Coffee Station
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Violation:
Cabinets above the coffee machines where tea, coffee, and other packaged food items were stored were also soiled with sticky residue, coffee granules, and general debris.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (2) In a clean, dry location; (3) Where it is not exposed to splash, dust, or other contamination; (4) At least 150 millimeters (6 inches) above the deck; (5) At least 127 millimeters (5 inches) for food in packages and working containers on pallets, skids, and racks; and (6) At least 150 millimeters (6 inches) above the deck on shelving racks.
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Item No.:
19
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Site:
Other-Bridge - Gyro Room
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Violation:
Two boxes of canned water, a case of soda, a case of individual packaged instant noodles, and a box of packaged coffee was stored on the deck inside this room. The room was not designed to dry food storage standards with carpet decking and electric cables and ductwork in the open deckhead above.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (2) In a clean, dry location; (3) Where it is not exposed to splash, dust, or other contamination; (4) At least 150 millimeters (6 inches) above the deck; (5) At least 127 millimeters (5 inches) for food in packages and working containers on pallets, skids, and racks; and (6) At least 150 millimeters (6 inches) above the deck on shelving racks. Do not store foods: (10) In areas not finished in accordance with 7.7.4 and 7.7.5 for food storage areas.
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Item No.:
19
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Site:
Buffet-Deck 9 - Cabanas Buffet Line Port Side
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Violation:
The handle of a serving tong was touching sausage links out for passenger self-service. The tong was removed to be cleaned and sanitized.
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Recommendation:
During pauses in food preparation or dispensing, ensure food preparation and dispensing utensils are stored: (1) In the food with their handles above the top of the food and the container.
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Item No.:
21
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Site:
Other-Bridge - Coffee Station
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Violation:
The coffee counter was made of wood with an apparent laminate top surface which was not durable.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material.
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Item No.:
26
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Site:
Other-Bridge - Coffee Station
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Violation:
The two coffee machines had an accumulation of old coffee residue on the underside of the dispensing nozzles.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
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Site:
Buffet-Deck 1 - Crew Mess
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Violation:
A soiled knife was in the utensil holder with other previously cleaned and sanitized utensils out for self service.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
27
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Site:
Other-Bridge - Coffee Station
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Violation:
The coffee counter was made of wood with an apparent laminate top surface which was not durable. The surface underneath the coffee machines and water dispensing machine was soiled with more than a day's accumulation of old coffee residue and general debris. Cabinets above the coffee machines where tea, coffee, and other packaged food items were stored were also soiled with sticky residue, coffee granules, and general debris.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
28
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Site:
Buffet-Deck 1 - Crew Mess
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Violation:
A soiled knife was in the utensil holder with other previously cleaned and sanitized utensils out for self service.
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Recommendation:
Store cleaned equipment and utensils, laundered linens, and single-service and single-use articles: (1) in a clean, dry location; (2) in a location where they are not exposed to splash, dust, or other contamination; (3) at least 150 millimeters (6 inches) above the deck unless in packages on pallets, skids, or racks, which may be 127 millimeters (5 inches).
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Item No.:
33
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Site:
Other-Bridge - Coffee Station
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Violation:
There was no coving at the bulkhead/deck junctures below the coffee station. Old coffee residue was located in these difficult to clean areas and beneath the refrigerator.
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Recommendation:
Cove all bulkhead/deck, equipment/deck, cabinet/deck, and deck sink coaming/deck junctures (including galleys, pantries, buffets, bars, waiter stations, dining room work counters, provisions, food storage rooms, equipment/utensil storage rooms, and toilet rooms intended for use by galley personnel). Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
36
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Site:
Other-Bridge - Coffee Station
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Violation:
Light intensity could not reach 220 lux of light at the coffee counter nor 110 lux behind and around beverage equipment.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) at a distance of 75 centimeters (30 inches) above the deck when in use, in walk-in refrigerator units and dry storage areas, and in other areas and rooms during periods of cleaning. Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment. Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas.
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Item No.:
39
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Site:
Buffet-Deck 9 - Cabanas Aft Beverage Station
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Violation:
A small fly was near the left soda dispenser. The area was in operation.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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Item No.:
39
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Site:
Buffet-Deck 9 - Cabanas Beverage Station Starboard Side
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Violation:
A small fly was near the juice dispenser. The area was not in operation.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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Item No.:
39
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Site:
Buffet-Deck 9 - Cabanas Buffet Line Starboard Side
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Violation:
One house fly was near the handwashing station. The area was not in operation.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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Item No.:
39
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Site:
Buffet-Deck 9 - Pinocchio?s
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Violation:
Four flies were near the deck by the stacked ovens. The area was not in operation.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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