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Item No.:
01
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Site:
Medical-4-Hour and 24-Hour Reporting
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Violation:
The same 24-hour and 4-hour reports were submitted for the voyage on December 16, 2012 even though there was no increase in the number of reportable cases. For the voyage on December 30, 2012, the 24-hour report was sent on January 6, 2013, the day of arrival, and the 4-hour report was sent 24 hours before arrival on January 5, 2013. For the voyage on December 23, 2012, a 4-hour report was submitted on December 30, 2012, but indicated 12 passenger cases instead of 14 passenger cases. Upon review, the two additional cases were reportable before the ship was 4 hours from the port.
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Recommendation:
If the number of cases changes after submission of the initial report, submit an updated report no less than 4 hours before the vessel's arrival at the U.S. port. Ensure that the 4-hour update report contains a cumulative total count of the reported crew and passengers during the entire cruise, including the additional cases.
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Item No.:
02
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Site:
Medical-Reportable Case Definition
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Violation:
During the voyage of January 13, 2013, a food worker had two loose stools within 24 hours that was above normal for the individual, but this case was recorded as nonreportable in STARDOCS, the vessel's electronic medical database. Also, during the voyage of December 23, 2012, a food worker had two loose stools within 24 hours that was above normal for the individual and stomach cramps, but this case was recorded as nonreportable in STARDOCS. During the voyage on December 16, 2012, this same individual had two loose stools within 24 hours that was above normal for the individual, stomach cramps, and muscle aches but this case was recorded as non-reportable in STARDOCs. According to the staff, if an individual has less than three episodes of diarrhea within 24 hours that is above normal for an individual, STARDOCS automatically indicated the individual as a nonreportable case. Staff also stated this was a system error and the program cannot be changed manually.
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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]). Correct STARDOCS so that individuals with less than three episodes of diarrhea within 24 hours can be indicated as a reportable case if the symptoms are above normal for the individuals.
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Item No.:
08
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Site:
Potable Water-Bunkering - Potable Water Hoses
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Violation:
During the preparation of bunkering potable water, the open ends of the potable water hoses were in direct contact with stagnant water on the pier. The staff disinfected the open ends and flushed the hoses before bunkering.
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Recommendation:
Handle potable water hoses with care to prevent contamination from dragging their ends on the ground, pier, or deck surfaces, or from dropping the hose into contaminated water.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Program
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Violation:
The list of backflow prevention devices indicated the devices installed on the evaporators were double check valves. Upon inspection, these devices were reduced pressure assemblies.
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Recommendation:
Update the type of backflow prevention devices installed on the evaporators on the cross-connection control list.
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Item No.:
10
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Site:
Recreational Water Facilities-Turnover Rates and Flow Meters
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Violation:
The turnover rates for six out of eight whirlpools did not meet the maximum turnover rate as required by the 2011 VSP Operations Manual. Specifically, the turnover rate for the whirlpools at aft port, mid port and mid starboard was calculated at 39 minutes, the turnover rate for the whirlpool in the spa was calculated at 44 minutes, and the turnover rate for the Serenity port whirlpool was calculated at 34 minutes. According to staff, flow meters have not been installed yet on these whirlpools and the turnover rates were calculated using the pump capacities.
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Recommendation:
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. Install flow meters and calculate the turnover rate using the new meters.
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Item No.:
11
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Site:
Medical-Crew Isolation
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Violation:
During the voyage of January 13, 2013, a food worker had two loose stools within 24 hours that was above normal for the individual, but this case was recorded in STARDOCS as nonreportable. The last symptoms were on January 15, 2013, but this individual was released from isolation on January 16, 2013. According to their work record, this person worked on January 16, 2013. Also, during the voyage of December 23, 2012, a food worker had two loose stools within 24 hours that was above normal for the individual and stomach cramps, but this case was recorded as nonreportable in STARDOCS. This individual was isolated for 48 hours. During the voyage on December 16, 2012, this same individual had two loose stools within 24 hours that was above normal for the individual, stomach cramps, and muscle aches but this case was recorded as non-reportable in STARDOCs. Their last symptoms were on December 18, 2012 at 3:26 p.m. and they were released on December 19, 2012 at 4:11 p.m. According to their time card, this person worked two shifts on both December 19 and 20, 2012.
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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.
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Item No.:
11
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Site:
Medical-Crew Reporting
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Violation:
A nonfood worker had AGE symptoms on December 29, 2012 at 11:30 p.m., but did not report to the medical center until December 30, 2013 at 10:06 a.m. This person did not work while symptomatic.
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Recommendation:
Ensure crew members report to medical immediately after the onset of their first AGE symptom.
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Item No.:
13
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Site:
Galley-Cooling Logs
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Violation:
The chef in charge did not ensure staff were monitoring food temperatures to ensure hot foods were reaching 70F or less within 2 hours of cooling and as a result, it was unknown if the foods were cooled correctly. The cooling log for potato soup indicated that on January 16, 2013 the soup was cooled from 144F at 3:36 p.m. and then at some point during the cooling process the food was measured at 38F. Also, the cooling log for a tomato reduction sauce indicated the sauce was cooled from 148F at 1:30 pm. on January 15, 2013 and at some point the sauce was measured at 38F by staff.
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Recommendation:
Ensure the supervisor or person in charge of food operations on the vessel monitors that: (7) Employees are using proper methods to rapidly cool potentially hazardous foods that are not held hot or are not for consumption within 4 hours.
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Item No.:
16
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Site:
Galley-Cooling Temperatures
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Violation:
The cooling log for potato soup indicated on January 16, 2013 the soup was cooled from 144F at 3:36 p.m. and after an unknown amount of time, the soup was measured at 38F by staff. Also, the cooling log for a tomato reduction sauce indicated the sauce was cooled from 148F at 1:30 pm. on January 15, 2013 and after an unknown amount of time, the sauce was measured at 38F by staff. It was unknown if either of these foods reached 70F or less within two hours of cooling.
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Recommendation:
Ensure cooked potentially hazardous food is cooled from 57C (135F) to 21C (70F) within 2 hours and from 21C (70F) to 5C (41F) or less within 4 hours.
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Item No.:
16
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Site:
Buffet-Time Control Plan
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Violation:
The time control plan was not posted at or near this food outlet.
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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): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such). (3) Describe or show the flow of potentially hazardous food from when last in temperature control to placement in time control and discard.
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Item No.:
17
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Site:
Galley-Cooling Logs
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Violation:
The cooling log for potato soup indicated on January 16, 2013 the soup was cooled from 144F at 3:36 p.m. and after an unknown amount of time, the soup was measured at 38F by staff. The soup was removed from the blast chiller at 7:10 p.m. the same day. Also, the cooling log for a tomato reduction sauce indicated the sauce was cooled from 148F at 1:30 pm. on January 15, 2013 and after an unknown amount of time, the sauce was measured at 38F by staff. The sauce was removed from the blast chiller at 5:10 p.m. the same day. It was unknown if either of these foods reached 70F within two hours of cooling.
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Recommendation:
Ensure logs documenting cooked potentially hazardous food cooling temperatures and times from the starting points designated in 7.3.5.2.1 thru the control points at 2 and 6 hours are maintained onboard the vessel for a period of 30 days from the date the food was placed in the cooling process.
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Item No.:
18
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Site:
Provisions-Meat Thawing Room
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Violation:
There were five containers of raw ground beef above one container of raw steaks and one container of raw lamb. The steaks and lamb were removed.
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Recommendation:
Protect food from cross-contamination or other sources of contamination by the following methods: (2) Separating types of raw animal foods from each other such as beef, fish, lamb, pork, and poultry-except when combined as ingredients-during storage, preparation, holding, and display by using separate equipment for each type, or by arranging each type of food in equipment so that cross-contamination of one type with another is prevented, or by preparing each type of food at different times or in separate areas.
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Item No.:
20
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Site:
Buffet-Deck 9 - Grand Buffet Deli Pantry
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Violation:
The food slicer on the left had a seam on the back plate that was difficult to clean.
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Recommendation:
Seal the seam.
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Item No.:
21
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Site:
Galley-Platinum Warewashing
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Violation:
The cloth insulation on the forward steam pipe was loose and fraying in several areas under the clean end of the glasswash machine.
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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.:
26
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Site:
Galley-Ice Machine
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Violation:
There was excess gray sediment in the left water bath compartment.
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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:
Galley-Ice Crusher Machine
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Violation:
There was a yellow food residue on the ice deflector plate on the inside of the machine. The machine was taken out of service to be washed 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.:
26
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Site:
Room Service-Ice Machine
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Violation:
There was excess gray sediment in both water bath compartments.
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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 9 - Grand Buffet Deli Pantry
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Violation:
A small amount of food grease was in the seam of the slicer.
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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:
Bar-Deck 5 - Coffee Bar
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Violation:
There was a small amount of white residue under the gasket in the top of the pressurized whipped cream dispenser .
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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 9 - Grand Buffet Cold Prep Pantry
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Violation:
A manual multi-blade food slicer stored on an undercounter shelf had dust on the blades.
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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.:
28
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Site:
Bar-Deck 9 - Iguana Bar
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Violation:
A large extension cord used in maintenance work on the deck above was found plugged into an electrical outlet on the bar's service counter. The cord draped across the bar and along the dispensing head of the carbonated beverage machine. The bar was not in operation.
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Recommendation:
Store cleaned equipment and utensils: (1) in a clean, dry location; and (2) in a location where they are not exposed to splash, dust, or other contamination.
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Item No.:
28
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Site:
Galley-Warewashing
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Violation:
There were 14 stacks of plates that were not covered or inverted and stored in a pre-check area. The plates were not checked or washed during the inspection.
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Recommendation:
Store clean equipment and utensils in a self-draining position that allows air drying, and covered or inverted.
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Item No.:
36
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Site:
Galley-Ice Machine
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Violation:
The light intensity on the left side of the deck-mounted ice cube machine was less than 110 lux.
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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:
Buffet-Lighting
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Violation:
The light intensity was less than 220 lux on some areas of the worker side of the buffet line.
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Recommendation:
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-Time Control Refrigerators
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Violation:
There was one live large fly in front of reach-in refrigerator #C6.
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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:
Medical-Staff Toilet Room
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Violation:
The handwashing sink was a men's urinal and was not properly designed for handwashing. Also, there were no paper towels or other method to dry hands available and there was no sign advising users to wash their hands.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (1) Hot and cold running water; (2) Soap; (3) A method to dry hands; (4) A sign advising users to wash hands. Remove the urinal and install a proper handwashing station.
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Item No.:
44
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Site:
Medical-Knowledge of Acute Gastronenteritis (AGE) Medical Operations
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Violation:
The lead nurse in charge of AGE reporting did not have the knowledge required on reporting reportable cases to VSP. In many cases the information reported to VSP was not correct, including the number of cases, type of reported needed, or the ports the ship visited. Also, they did not realize that several cases of crew were recorded as nonreportable instead of reportable and at least two food workers were not isolated for the correct amount of time. It was very difficult obtaining information in STARDOCS and from paper records, including tracking down the status of whether persons were isolated properly or if they were working when they should not have been.
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Recommendation:
Ensure the supervisor or person in charge of medical operations related to AGE on the vessel demonstrates to VSP-during inspections and on request-knowledge of medical operations related to AGE, is able to demonstrate this knowledge by compliance with Section 4 of the VSP 2011 Operations Manual or by responding correctly to the inspector's questions as they relate to the specific operation, and properly trains employees to comply with Section 4 of the VSP 2011 Operations Manual as it relates to their assigned duties.
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