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Item No.:
*
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The OPP level 2 in stateroom guest GI illness letter and some of the other letters refer to colds, flu, and stomach flu as well as gastrointestinal illness, when these letters are specifically about prevention of gastrointestinal illness.
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Recommendation:
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The electronic medical AGE surveillance log did not cover all the fields and was not ordered exactly as the one required in 13.2.2 of the VSP Operations Manual. The system was also not capable of exporting the exact AGE log provided in 13.2.2.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person?s name; (5) person?s age; (6) person?s sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (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) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Gastrointestinal (GI) Case Definition
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Violation:
The electronic database used onboard is loaded with an old definition of a GI illness case, in that it does not address diarrhea which is above normal for the individual. The system will not permit an individual to be a reportable case with fewer than 3 loose stools. It also does not allow a person with underlying medical conditions who normally have more than 3 loose stools daily to be diagnosed as non-reportable.
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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]).
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Item No.:
02
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Site:
Medical-GI Case Reporting
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Violation:
A crew member who reported to medical onset of two diarrheal episodes and abdominal cramps at 8 am on 30 November was seen at medical at 8 pm the same day, issued antidiarrheal medication and experienced another episode of diarrhea at 8 am on December 1. Although the medical response to the case patient was to isolate them until symptom free for at least 24 hours, this crew member was listed as non-reportable. The medical staff immediately updated the electronic system to add the final symptom and make this crew member a reportable GI illness case.
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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]).
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Item No.:
08
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Site:
Potable Water-Tank Coatings
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Violation:
The records for the potable water tank maintenance indicated that Interline 925 was used for coating with a hard drying time of more than 12 hours. Staff stated the temperature inside the tanks were approximately 25C. According to the manufacturer's recommendations, the hard drying time at this temperature is 18 hours. It could not be determined exactly how many hours the coating was allowed to dry.
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Recommendation:
Ensure the interior coatings on potable water tanks are approved for potable water contact by a certification organization. Follow all manufacturers? recommendations for application, drying, and curing. For the tank coatings used, maintain the following onboard: (1) written documentation of approval from the certification organization (independent of the coating manufacturer); (2) manufacturers? recommendations for application, drying, and curing; and (3) written documentation that the manufacturers? recommendations have been followed for application, drying, and curing.
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Item No.:
10
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Site:
Recreational Water Facilities-Automated Testing
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Violation:
The ship had automatic analyzers at all RWF's, but there were no chart recorders installed. A purchase order was placed on 11 December 2011.
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Recommendation:
Install chart recorders or electronic data loggers with security features that record pH and halogen measurements for each individual RWF. Ensure the sample line for the analyzer probe (monitoring) is either directly from the RWF or on the return line from each RWF and before the compensation tank. Install appropriate sample taps for analyzer calibration. In the event of equipment failure, measure free residual halogen and pH by a manual test kit at the RWF or return line at least hourly for whirlpool spas, spa pools, children?s pools, and wading pools and every 4 hours for all other RWFs. Record manual readings on a chart or log, retain for at least 12 months, and ensure that they are available for review during inspections. Complete repairs on malfunctioning halogen analyzer-chart recorders within 30 days of equipment failure. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Signs
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Violation:
The safety signs for all of the recreational water facilities did not include all of the information as required in the 2011 VSP Operations Manual. A purchase order was placed on 1 November 2011.
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Recommendation:
Provide safety signs for all RWFs, except for baby-only water facilities. Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #. For children?s RWF signs, include the exact wording ?TAKE CHILDREN ON FREQUENT BATHROOM BREAKS? or ?TAKE CHILDREN ON FREQUENT TOILET BREAKS.?
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Item No.:
10
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Site:
Recreational Water Facilities-Shock Halogenation
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Violation:
The free residual halogen was not tested at both the start and completion of shock halogenation for the Kids Play Pool and the Flowrider.
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Recommendation:
Increase the free residual halogen to at least 10.0 mg/L (ppm) and circulate for at least 1 hour every 24 hours. Test the free residual halogen both at the start and completion of shock halogenation. Superhalogenate the water in the entire RWF system to 10 ppm to include the whirlpool spa/spa pool tub, compensation tank, filter housing, and all associated piping before starting the 1-hour timing.
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Item No.:
10
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Site:
Recreational Water Facilities-Whirlpool Antientrapment
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Violation:
The drain covers for the whirlpools were ASME A112.19.8 compliant, but were not stamped with all of the information as required in the 2011 VSP Operations Manual.
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Recommendation:
For RWFs with suction fittings and a single unblockable drain (per ASME A112.19.8-2007), provide an ASME A112.19.8 compliant antientrapment/antientanglement drain cover and a safety vacuum release system or automatic pump shut-off system.
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Item No.:
10
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Site:
Recreational Water Facilities-Swimming Pool Antientrapment
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Violation:
The pools had multiple gravity drains greater than 3 feet apart with covers created of a standard design and no alarms were installed.
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Recommendation:
For RWFs with gravity drainage and a single unblockable drain (per ASME A112.19.8), provide either a standard design (not compliant with ASME A112.19.8) drain cover and an alarm, or an ASME A112.19.8 compliant antientrapment/antientanglement drain cover. Ensure the alarm is audible and sounds in both a continuously manned space and at the RWF. Ensure this alarm is for all draining: accidental, routine, and emergency.
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Item No.:
10
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Site:
Recreational Water Facilities-Sample Lines
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Violation:
The sample lines and analyzers for the whirlpools were not directly from the whirlpools or on the return lines before the compensation tanks.
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Recommendation:
Install chart recorders or electronic data loggers with security features that record pH and halogen measurements for each individual RWF. Ensure the sample line for the analyzer probe (monitoring) is either directly from the RWF or on the return line from each RWF and before the compensation tank. Install appropriate sample taps for analyzer calibration. In the event of equipment failure, measure free residual halogen and pH by a manual test kit at the RWF or return line at least hourly for whirlpool spas, spa pools, children?s pools, and wading pools and every 4 hours for all other RWFs. Record manual readings on a chart or log, retain for at least 12 months, and ensure that they are available for review during inspections. Complete repairs on malfunctioning halogen analyzer-chart recorders within 30 days of equipment failure. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF.
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Item No.:
11
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Site:
Medical-Crew Reporting
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Violation:
One crew facility cleaner experienced onset of diarrhea and stomach cramps at 8 am on 30 November but did not report to the medical facility until 8 pm the same day. This crew member worked from 5:27 pm to 7:23 pm the same day.
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Recommendation:
Exclude food employees suspected of, diagnosed with, or exposed to any communicable disease caused by Salmonella typhi, Shigella spp., E. coli O157:H7, hepatitis A virus, norovirus, or other communicable diseases that can be transmitted by food, from working in any food or food related areas or operations, including working with exposed food, warewashing, equipment, utensils, table linens, single-service articles and single-use articles. Do not allow the excluded individual to return to the above duties until they are symptom free for a minimum of 48 hours. 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.
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Item No.:
16
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Site:
Buffet-Consumer Advisory
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Violation:
Ensure the consumer is informed by way of disclosure using placards, or other easily visible written means of the significantly increased risk to certain individuals especially vulnerable consumers of eating undercooked seafood or eggs in buffet operations where these specific foods are in raw or undercooked form. Locate the advisory at the outlets where these types of food are served. [New requirement 2011 VSP Operations Manual]
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Recommendation:
If an animal food such as beef, eggs, fish, lamb, milk, pork, poultry, or shellfish that is raw, undercooked, or not otherwise processed to eliminate pathogens is offered in a ready-to-eat form or as a raw ingredient in another ready-to-eat food, ensure the consumer is informed by way of disclosure using menu advisories, placards, or other easily visible written means of the significantly increased risk to certain especially vulnerable consumers eating such foods in raw or undercooked form. Locate the advisory at the outlets where these types of food are served. Ensure that raw shell egg preparations are not used in uncooked products as described in section 7.3.3.2.3. Ensure that disclosure is made by one of the two following methods: (1) On a sign describing the animal-derived foods (e.g., ?oysters on the half-shell,? ?hamburgers,? ?steaks,? or ?eggs?); AND that they can be cooked to order and may be served raw or undercooked; AND a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, poultry may increase your risk for foodborne illness, especially if you have certain medical conditions. Ensure the advisory is posted at the specific station where the food is served raw, undercooked, or cooked to order OR (2) On a menu using an asterisk at the animal-derived foods requiring disclosure and a footnote with a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, or poultry may increase your risk for foodborne illness, especially if you have certain medical conditions.
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Item No.:
16
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Site:
Food Service General-Time Control Plan
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Violation:
The time control plans posted in the food outlets listed the equipment being used for time control but not all of the equipment was physically labeled as such. Staff did some labeling during the inspection.
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Recommendation:
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such).
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Item No.:
16
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Site:
Galley-Deck 5, Cold Galley
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Violation:
The date marking on a container of pasta salad did not correspond to the date the pasta was cooked(first ingredient), rather when all the ingredients were added. The cooling log indicated the rigatoni pasta was cooked and cooled on 27 DEC and then mixed with other ingredients on 29 DEC. The date marking for the product was 7 days from 29 DEC.
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Recommendation:
Ensure refrigerated, ready-to-eat, potentially hazardous food is discarded if not consumed within 7 calendar days from the date of preparation or opening.
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Item No.:
21
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Site:
Galley-Deck 3 - Hot Galley
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Violation:
Rust was observed on the mixing bowl bracket of a large deck-mounted mixer.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines.
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Item No.:
21
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Site:
Galley-Deck 4 - Bakery
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Violation:
Proofer (#4023) had a large open seam on the right interior panel that was difficult to clean.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines.
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Item No.:
22
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Site:
Galley-Windjammer Glasswash (Port)
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Violation:
The upper rinse arm of the active rack-type glasswash was not attaching properly to the water inlet connection which resulted in water spraying from this connection point disrupting the spray patterns for both the rinse and sanitizing spray. This was corrected during the inspection
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Recommendation:
Maintain warewashing equipment in good repair and proper adjustment, including: (1) warewashing equipment is maintained in a state of repair and condition that meets the standards of the materials, design, and construction of these guidelines; (2) water pressure and water temperature-measuring devices are maintained in good repair and accurate within the intended range of use.
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Item No.:
26
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Site:
Galley-Deck 5, Glasswash
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Violation:
A previously cleaned and sanitized shot glass was observed soiled with a sugar residue. The entire rack was sent back to be cleaned and sanitized.
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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:
Galley-Deck 4 - Bakery
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Violation:
Proofer (#4007) appeared to have mold behind the ventilation fan in the upper interior of the proofer cabinet.
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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.:
33
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Site:
Galley-Windjammer - Hot Galley
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Violation:
A cracked deck tile was observed near the edge of the middle deck sink below the tilting kettle. A work order had been submitted.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
36
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Site:
Other-Cafe Promenade Beverage Station
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Violation:
The lighting behind the counter mounted coffee machines could not reach 110 lux. (New requirement 2011 VSP Manual)
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Galley-Deck 3 - Hot Galley - Roast Station
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Violation:
Light levels behind the bank of steamer ovens was measured at approximately 50 lux. (New requirement for 2011 VSP Operations Manual).
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
37
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Site:
Galley-Deck 3 - Dishwashing
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Violation:
Dripping condensate was noted above the conveyor dishwasher. A large amount of steam was coming out of top of the door seam where the door was not tight fitting.
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Recommendation:
Ensure ventilation hood systems and devices operate effectively to prevent condensate from collecting on the deckheads and remove contaminants generated by equipment located under them.
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Item No.:
37
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Site:
Galley-Deck 2 - Hot Station
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Violation:
Condensate was dripping from the hood above the combination steamer ovens. The ovens were producing a large amount of steam from a lower vent pipe. The hood ventilation fan was working.
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Recommendation:
Ensure ventilation hood systems and devices operate effectively to prevent condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
37
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Site:
Galley-Deck 3 - Hot Service Line
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Violation:
Condensate was noted on the back wall and lower portion of the plate counter above the center and aft baines marie units at the end of the breakfast service period. Condensate appeared to be coming from the high temperature of the water and the steam escaping from the perforated inserts spaces between the pans. No food was impacted.
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Recommendation:
Ensure ventilation hood systems and devices operate effectively to prevent grease and condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
Although the electronic response plan (OPP) defined where the disinfectant Oxivir was to be used and the contact time, it was not made clear what the concentration of the product should be.
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Recommendation:
Ensure each vessel has a written OPRP that details standard procedures and policies to specifically address AGE onboard. Include the following in the written OPRP: (1) Duties and responsibilities of each department and their staff for all the passenger and crew public areas; (2) Steps in outbreak management and control and the trigger for required action at each step. Ensure the triggers address a graduated approach to outbreak management in response to increasing case counts; (3) Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times. Ensure the disinfectant products or systems are effective against human norovirus or an acceptable surrogate (e.g., caliciviruses); (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak; (6) Procedures to protect the passengers and crew from exposure to disinfectants, if not already included in the vessel?s safety management system. Ensure this protection includes: (a) Material safety data sheets (MSDSs); (b) Personal protective equipment for crew; (c) Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
There were two letters provided to passengers embarking following an elevated GI illness voyage (referred to as OPP level 2). The first letter is provided at the terminal and it correctly advised of the elevated GI cases on the previous voyage, while the second letter placed in each individual passenger cabin did not mention any elevated GI illness condition on the previous cruise. The combination of these two letters, received on the same boarding day would serve to confuse passengers rather than educate them.
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Recommendation:
Review both letters and ensure that they do not conflict in first raising awareness of increased gastrointestinal illness on the previous cruise at the terminal and at each cabin providing another letter which does not indicate a problem from the previous cruise.
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Item No.:
42
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Site:
Children Area-Adventure Ocean
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Violation:
The child toilet seats were over 11 inches above the deck and no step stools were provided. Additionally the seat openings exceeded the maximum 8 inches.
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Recommendation:
If toilet rooms are located in a child-activity center, provide a child-size toilet(s) or child-accessible toilet(s) (child-size seat and step stool) and handwashing facilities. Ensure child-size toilets (to include the toilet seat) have a maximum height of 280 millimeters (11 inches) and a toilet seat opening no greater than 203 millimeters (8 inches). Ensure handwashing sinks have a maximum height of 560 millimeters (22 inches) above the deck or a step stool.
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Item No.:
42
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Site:
Children Area-Adventure Ocean
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Violation:
The exclusion policy and procedure to follow for symptomatic children in the child center was not posted at the entrance now used at the center.
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Recommendation:
Ensure the child activity center has a written exclusion policy on procedures to be followed when a child develops symptoms of an infectious illness while at the center. Ensure the exclusion policy includes a requirement for written clearance from the medical staff before a child with symptoms of infectious illness can be allowed in the child activity center. Post the policy at the entrance of the child activity center.
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Item No.:
42
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Site:
Children Area-Adventure Ocean
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Violation:
The Oxivir Five 16 spray disinfectant was used to disinfect small children's toys such as building blocks between sessions. The staff require gloves and respirators to use this product and given the open voids in the small toys it is not certain they will always be completely dry before use by a child.
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Recommendation:
Ensure surfaces that children touch with their hands are cleaned and disinfected at least daily with products labeled by the manufacturer for that purpose.
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