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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 database used for collecting AGE illness information could not be exported into the standardized AGE surveillance log exactly as it appears in the 2011 VSP Operations Manual.
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Recommendation:
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-AGE Case
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Violation:
The electronic database used for collecting AGE case information used the previous VSP definition for an AGE illness case and did not consider diarrhea in excess of what was normal for the individual. A person with an underlying medical conditions was reported as an AGE case due to this database error.
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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; 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-AGE Case
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Violation:
The electronic database for AGE illness tracking did not include the ability to add symptoms when non-cases and cases were followed up to evaluate their condition daily. Notes were permitted to be added, but they did not detail symptoms, except to state the patient had more symptoms.
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Recommendation:
Update the AGE electronic database so additional symptoms can be added during patient's evaluations.
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Item No.:
10
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Site:
Recreational Water Facilities-Alkalinity and Clarity
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Violation:
Staff were not monitoring the swimming pools and whirlpool spas for total alkalinity or clarity.
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Recommendation:
Monitor and adjust the RWF's flow rates, free and combined halogen levels, pH, total alkalinity, and clarity as recommended by the manufacturer and to maintain optimum public health protection and water chemistry.
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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 the swimming pools and whirlpool spas did not include any of the statements required in the 2011 VSP Operations Manual.
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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." In addition to the safety sign requirements in section 6.7.1.1.1, install a sign at each whirlpool spa and spa pool entrance listing precautions and risks associated with the use of these facilities. Include, at a minimum, cautions against use by the following: (1) individuals who are immunocompromised; (2) individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure; and (3) pregnant women, elderly persons, and children. Additionally, caution against exceeding 15 minutes of exposure.
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Item No.:
10
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Site:
Recreational Water Facilities-Flow Meters
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Violation:
There were no flow meters on any of the swimming pools or whirlpool spas. The turnover rates and bather load were not calculated for any swimming pool or whirlpool spa.
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Recommendation:
Monitor and adjust the RWF's flow rates, free and combined halogen levels, pH, total alkalinity, and clarity as recommended by the manufacturer and to maintain optimum public health protection and water chemistry. Install flow meters at all RWFs. For RWFs with skim gutters, ensure that the fill level of the RWF is to the level of the skim gutters. Design recirculation systems and equipment, including chemical control equipment, UV disinfection systems, filter, and pumps to maintain adequate water chemistry control while operating at the following minimum turnover rates: (1) swimming pool (VSP 2005 Construction Guidelines or earlier): 6 hours; (2) swimming pool (VSP 2011 Construction Guidelines or later): 4 hours; (3) children's pool: 0.5 hours; (4) wading pool: 1 hour; (5) whirlpool spa: 0.5 hours; (6) spa pool: 2 hours; (7) interactive RWF or activity pool less than 610 millimeters (24 inches) deep: 1 hour; (8) interactive RWF or activity pool greater than 610 millimeters (24 inches) deep: 2 hours; and (9) baby-only water facility: 0.5 hours. Ensure an RWF slide that is combined with a pool has a turnover rate that matches the rate for the pool. Maintain documentation on the maximum bather load for each RWF. Ensure the maximum bather load is based on the following factor: one person per five gallons (19 liters) per minute of recirculation flow.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment
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Violation:
Each of the three swimming pools had two or more gravity drains greater than three feet apart constructed of a standard design and no alarms were installed. The suction drain covers on all of the whirlpool spas did not meet the requirements of the 2011 VSP Operations Manual and were not stamped accordingly.
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Recommendation:
For RWFs with gravity drainage and multiple drains (2 or more drains greater than 3 feet apart), 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. For RWFs with suction fittings and a single blockable drain or multiple drains (less than 3 feet apart), provide an ASME A112.19.8 compliant antientrapment/antientanglement drain cover and a safety vacuum release system or automatic pump shut-off system. Ensure the testing of manufactured drain covers is by a nationally or internationally recognized testing laboratory. Ensure the following information is stamped on each manufactured antientrapment drain cover: (1) certification standard and year; (2) type of drain use (single or multiple); (3) maximum flow rate (in gallons or liters per minute); (4) type of fitting (suction outlet); (5) life expectancy of cover; (6) mounting orientation (wall, floor, or both); (7) manufacturer's name or trademark; and (8) model designation.
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Item No.:
20
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Site:
Dining Room-Normandie Restaurant Port Pantry
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Violation:
There were slotted fasteners in the food splash zone of the two coffee dispensers.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
21
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Site:
Buffet-Starboard Beverage Station
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Violation:
There was a seam on the counter top near the front right corner of the water/ice dispensing machine. Staff immediately sealed the seam.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
25
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Site:
Bar-Lobby Bar
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Violation:
Some wet wiping cloths were stored in an empty container without chemical sanitizing solution.
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Recommendation:
Restrict wiping cloths to the following: (2) Cloths used for wiping food spills are dry and used for wiping food spills from tableware and single service articles or wet and cleaned, stored in a chemical sanitizer, and used for wiping spills from food-contact and nonfood-contact surfaces of equipment.
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Item No.:
33
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Site:
Provisions-Meat Freezer
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Violation:
Some of the stainless steel deckhead profile strips were loose, creating seams and gaps. Staff stated a work order had been placed and the profile strips were scheduled to be welded on the day of the inspection.
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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:
Provisions-Beer Room
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Violation:
The light intensity was less than 110 lux in one of the liquor store aisles. There were no lights installed in this aisle.
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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.
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Item No.:
36
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Site:
Bar-Lighting
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Violation:
Under normal operating conditions, the light intensity at the handwashing station in the Cafe Piazza and the Casino Bar was less than 110 lux. There was a bulkhead-mounted light at the handwashing station in the Casino Bar that would increase the light intensity above 110 lux. Staff was not aware this light needed to remain on during operation. These areas were open at the time of the inspection.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) at handwashing stations in bars.
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Item No.:
36
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Site:
Dining Room-Normandie Restaurant
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Violation:
The maximum light intensity was less than 220 lux at some of the soiled waiter stations. This was mostly observed below the deckhead-mounted decorative opaque light fixtures.
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Recommendation:
In bars and dining room waiter stations, provide 220 lux (20 foot candles) light intensity during cleaning operations.
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Item No.:
36
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Site:
Food Service General-Lighting
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Violation:
The light intensity was less than 110 lux behind and around many pieces of deck- and counter-mounted equipment. Some of these areas include the Normandie Restaurant pantry beverage station, behind the ice machine in the main galley appetizer section, and to the right of the coffee machine in Cafe Piazza.
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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:
Pantry-Housekeeping Pantries
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Violation:
The light intensity was less than 110 lux behind and around the deck-mounted ice machines.
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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.:
39
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Site:
Galley-Pastry
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Violation:
There was one live fly near the blast chiller. 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.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
In many areas of the OPRP, the word 'frequently' was applied to the cleaning and disinfection of a hand contact surface. There were many food related areas where 1,000 ppm chlorine was specified for disinfection of refrigerator door handles, tongs, room service plates and trays, food and plate transport trolleys, ice scoops and all bar surfaces, provision hand contact surfaces, etc. Where Vital Oxide was specified to clean/disinfect, there was either no mixing ratio or no final concentration. In review of the product's label, there were specific mixing ratios or full strength listed for different applications and for destruction of specific pathogen types. In each section for a department there was no explanation of the product to be used on surfaces or the concentration and contact time for the product. In some cases an action was listed as 'if necessary close the pools or whirlpools,' or 'that in an outbreak the Hotel Director would determine if it was necessary to close the buffet to passenger self-service.'
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Recommendation:
When the cumulative proportion of cases of AGE among passengers or crew members is equal or greater than 2%, ensure the outbreak management response includes cleaning and disinfecting all public areas, including handrails and restrooms, on a continuous basis. Ensure the concentration of the chlorine sanitizing solution is between 50 and 200 ppm in food areas. 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: (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). When the cumulative proportion of cases of AGE among passengers or crew members is equal or greater than 2%, ensure precautions are taken to prevent the spread of the disease, such as closing recreational water facilities and prohibiting self-service at the buffets.
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Item No.:
41
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Site:
Housekeeping-OPRP
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Violation:
There were no letters to notify current passengers of an AGE outbreak. Additionally, the letters to notify oncoming passengers of an AGE outbreak on the previous voyage were not available. Small toys in the child activity center were to be soaked in 1,000 ppm chlorine and rinsed with water. There were no written procedures to protect passengers from the respiratory or dermal hazards from the disinfection chemicals used in spray, wipe, and fogging activities.
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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: (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; (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-Public Toilet Rooms
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Violation:
There were no signs in the public toilet rooms advising users to wash their hands. Also, there were no signs advising the use of the door-mounted tissues to open the door when exiting the toilet rooms.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (4) A sign advising users to wash hands. Post a sign advising users of toilet facilities to use hand towel, paper towel, or tissue to open the door unless the exit is hands free.
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Item No.:
43
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Site:
Ventilation-
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Violation:
The condensate collection pans were not visible from the access doors for the fan units. There was no fiber optic system available to properly inspect each condensate pan.
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Recommendation:
Ensure air handling unit condensate drain pans and collection systems are able to be accessed for inspection, maintenance, and cleaning. Install sight windows or use other effective methods to allow for full inspection of condensate collection pans when original equipment access makes evaluation during operational inspections impractical.
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Item No.:
43
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Site:
Ventilation-
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Violation:
Staff used technical water taps in the air conditioning fan rooms to clean the HVAC distribution system.
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Recommendation:
Use only potable water for cleaning HVAC distribution systems.
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