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Item No.:
02
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Site:
Medical-Public Vomit / Diarrhea Incident (PVI/PDI) Evaluations
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Violation:
The review of medical logs disclosed numerous instances when there were no notes about medical evaluations for incidents of persons vomiting or experiencing diarrhea in public areas or their cabins. It was unclear if these persons met the acute gastroenteritis (AGE) reportable case definition and were required to be isolated since no evaluation was documented. The inspector reviewed the handwritten PDI/PVI Log compiled by Guest Services and randomly selected at least eight cabin numbers for staff to demonstrate medical evaluation occurred for guest(s) occupying that cabin. No evaluation notes were available for any guest randomly selected.
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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 medical records document evaluations for public vomit/diarrhea incidents when the individuals involved are identified. Proper evaluation should include determining if the individuals meet the definition of an AGE reportable case and assessing the need for isolation.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
A review of the AGE Log from the 5 April - 7 May voyage indicated a guest who was misclassified as non-reportable AGE cases. For example:
Patient ID 91562 experienced one episode of diarrhea and three episodes of vomiting, was issued antidiarrheal medication and had no underlying illness. The AGE Log indicated this guest did not meet the AGE case definition. This guest returned to the medical center two days later with three episodes of diarrhea and was classified as an AGE reportable 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:
Pantry-Deck 7 - Club Fusion Multiflow Cabinet
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Violation:
Brown residue clogged the relief vents of the backflow prevention device for the multiflow soda unit.
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Recommendation:
Maintain backflow prevention devices in good repair.
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Item No.:
20
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Site:
Bar-Deck 14 - Calypso Bar
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Violation:
The coffee machine had slotted fasteners on one of the group heads.
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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.:
20
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Site:
Food Service General-Soda Guns
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Violation:
Slotted fasteners were on the food splash side of all the soda guns located throughout the ship.
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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:
Food Service General-World Fresh Market
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Violation:
The laminate coating on the undercounter cabinets on the worker sides of buffet stations was in poor condition throughout the buffet. The laminate was peeling and missing in many areas making it difficult to clean.
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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.:
27
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Site:
Buffet-Deck 14 - World Fresh Market Starboard Side Dessert Station
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Violation:
Black debris was around the back left toaster support leg. This was cleaned immediately.
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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:
Bar-Deck 14 - Swirls Ice Cream Bar
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Violation:
The dipper well and ice cream scoop were not protected by a sneeze guard.
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Recommendation:
Protect eating utensils dispensed at a consumer self-service unit such as a buffet or salad bar from contamination.
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Item No.:
30
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Site:
Galley-Deck 7 - Sabatini's
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Violation:
Water was continuously overflowing from the unisex toilet. Repairs started immediately.
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Recommendation:
Keep toilet fixtures clean and in good repair.
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Item No.:
30
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Site:
Buffet-Deck 14 - World Fresh Market Starboard Side
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Violation:
The handwashing station had black residue on the countertop behind the faucet.
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Recommendation:
Keep handwashing facilities clean and in good repair.
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Item No.:
33
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Site:
Pantry-Deck 14 - Oasis Bar
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Violation:
The right bulkhead panel was detached from the rest of the bulkhead.
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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.:
33
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Site:
Pantry-Deck 7 - Club Fusion Walk-In Refrigerator
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Violation:
Two open penetrations to void space were on the bulkhead in front of the condenser unit.
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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.:
33
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Site:
Galley-Deck 5 - Wine Cellar Walk-In Refrigerator
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Violation:
The deckhead hatch near the entrance of the room had multiple open penetrations leading to void space.
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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.:
34
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Site:
Galley-Deck 7 - Sabatini's
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Violation:
Water was continuously overflowing from the unisex toilet. Repairs started immediately.
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Recommendation:
Ensure a plumbing system in a food area is maintained in good repair.
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Item No.:
39
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Site:
Buffet-Deck 14 - World Fresh Market Forward Holding Pantry
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Violation:
A small fly was in the area. 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:
Galley-Deck 5 - Bakery
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Violation:
A small fly was by the proofers. 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:
Bar-Deck 7 - Club Fusion
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Violation:
Two small flies were around the handwashing station.
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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 14 - World Fresh Market Starboard Side
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Violation:
A small fly was at the forward waiter station behind the beverage station. 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.:
44
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Site:
Other-Housekeeping / Guest Services Communication
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Violation:
A review of the handwritten Public Diarrhea Incident / Public Vomiting Incident (PDI / PVI) Log from 8-24 April alongside Medical Staff and Rooms Division Staff demonstrated a lack of communication between the departments. Medical staff were not made aware of guests who experienced vomiting or diarrhea in the cabin or public areas and were unable to properly medically evaluate. Rooms Division Staff did not have records of at least six PDI/PVI to provide proper cleaning and sanitizing of the area. To include (1) Santa Fe Dining Room (13 April); (2) Horizon Court (20 April); (3) Outside Security Office (24 April); (4) Cabin 3415 (24 April); (5) Cabin 3235 (24 April). This lack of communication was likely a contributing factor to an ongoing AGE outbreak.
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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 2018 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 2018 Operations Manual as it relates to their assigned duties.
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