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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 AGE surveillance system was not able to provide an AGE surveillance log that contained all of the required data and in the same format as in Annex 13.2.2 of the 2011 VSP Operations Manual. Also, the system did not allow the medical staff to remove a person as a case if they had an underlying illness as the cause of symptoms or add them as a case if they had gastroenteritis illness, but did not fully meet the case definition.
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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.
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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 AGE surveillance system was not able to provide an AGE surveillance log that contained all of the required data and in the same format as in Annex 13.2.2 of the 2011 VSP Operations Manual. Also, the system did not allow the medical staff to remove a person as a case if they had an underlying illness as the cause of symptoms or add them as a case if they had gastroenteritis illness, but did not fully meet the case definition.
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Recommendation:
Ensure the electronic AGE surveillance system allows medical staff to enter and remove a patient as a case if they meet the case definition or if they have AGE symptoms that are considered above normal for the individual.
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Item No.:
08
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Site:
Potable Water-Production
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Violation:
There was no documentation of pH monitoring conducted at least every four hours during the production of potable water.
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Recommendation:
After the free residual halogen level of at least 2.0 mg/L (ppm) and pH level not exceeding 7.8 have been reached, monitor the free residual halogen and pH at least once every 4 hours during the production of potable water.
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Item No.:
08
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Site:
Potable Water-Production
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Violation:
There was no documentation of pH monitoring conducted at least every four hours during the production of potable water.
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Recommendation:
Maintain accurate records of production and bunkering monitoring aboard for 12 months and ensure these records are available for review during inspections.
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Item No.:
08
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Site:
Potable Water-Striping
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Violation:
The distillate lines for the three evaporators and the permeate line on the reverse osmosis system were not striped blue/gray/blue to the chlorine injection system.
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Recommendation:
Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings, including potable water supply lines in technical lockers.
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Item No.:
08
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Site:
Food Service General-Refrigerant Brine Lines
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Violation:
The refrigerant brine lines were not uniquely identified.
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Recommendation:
Uniquely identify all refrigerant brine lines in all galleys, pantries, and cold rooms to prevent cross-connections.
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Item No.:
08
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Site:
Buffet-Lido Deli
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Violation:
There was a leak from the vent on the hood cleaning cabinet backflow prevention device. The device was replaced.
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Recommendation:
Maintain backflow prevention devices in good repair.
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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 RWFs did not meet the requirements of the 2011 VSP Operations Manual.
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Recommendation:
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-Safety Signs
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Violation:
The safety signs for the RWFs did not meet the requirements of 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.?
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Item No.:
11
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Site:
Medical-Crew Illness Reporting
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Violation:
A dancer had an onset of AGE symptoms on February 23, 2012 at 7:00 a.m. and did not report to medical until February 25, 2012 at 3:00 p.m.
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Recommendation:
Ensure nonfood employees who have AGE symptoms report to the vessel's medical staff immediately.
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Item No.:
16
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Site:
Other-Sushi Bar
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Violation:
The time control plan was not posted in the bar.
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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.
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Item No.:
16
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Site:
Other-Sushi Bar
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Violation:
The menus for the sushi items had a consumer advisory at the bottom, but did not include an asterisk by the items containing fish served raw or undercooked.
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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 disclosure is made by one of the two following methods: (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:
Buffet-Deli
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Violation:
The hot holding cabinet was listed on the time control plan as a time control unit, but the unit was not labeled.
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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:
Buffet-Omelet Station
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Violation:
The consumer advisory posted at the omelet station had a statement indicating the risk of consuming raw or undercooked animal derived foods, but there was no statement that eggs could be cooked to order and served undercooked.
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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. (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.
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Item No.:
16
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Site:
Buffet-Officer's Mess
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Violation:
The consumer advisory for the menu in the officer's mess included a statement indicating the risk of consuming raw or undercooked animal derived foods, but there was an asterisk on the menu for the category labeled 'also available.' Several food items were listed after this label, but eggs were the only animal-derived product that could be served raw or undercooked.
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Recommendation:
Ensure the asterisks indicating animal-derived foods that require a consumer advisory are at the specific food items, and not general categories.
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Item No.:
16
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Site:
Galley-Appetizer Pantry
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Violation:
The time control plan for hot foods had a box indicating the temperatures to which these foods should be cooked. One of the arrows from this box pointed to another box stating that foods on time control should be placed in time control refrigerators. There was no indication on the plan that foods should be cooled before going to time control in refrigerators. The time control plan was corrected.
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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): (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.:
20
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Site:
Food Service General-Scharf Espresso Machines
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Violation:
The food splash zone above the coffee and steamer area of these espresso machines was difficult to clean due to exposed pipes and wires. Staff stated that cover panels were planned for installation on these machines.
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Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (3) finished to have a smooth, easily cleanable surface.
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Item No.:
21
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Site:
Bar-Crimson Dining Room Service
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Violation:
The pipe insulation in the undercounter refrigerator technical compartment was shriveled and wet. According to the staff, new insulation had been ordered.
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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.:
22
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Site:
Pantry-Plaza Bar
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Violation:
The data plate for the warewash machine was located below the clean counter and was not easily accessible to the workers.
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Recommendation:
Ensure a warewashing machine is provided with an easily accessible and readable data plate affixed to or posted adjacent to the machine that indicates the machine?s design and operating specifications.
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Item No.:
27
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Site:
Bar-Crimson Dining Room Service
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Violation:
The pipe insulation in the undercounter technical compartment was soiled.
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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.:
27
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Site:
Galley-Center Galley
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Violation:
The knob and some of the pipe insulation in undercounter refrigerator technical compartment TC3MG-6 was soiled.
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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.:
36
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Site:
Bar-Handwash Light Intensity
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Violation:
The light intensity at the Steakhouse Bar and the Plaza Bar handwashing stations was less than 110 lux during normal lighting.
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Recommendation:
Ensure the light intensity at the handwashing stations is measured at all bars and at night at exterior bars or those with windows to the outside where natural light may influence the measurement.
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Item No.:
36
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Site:
Bar-Handwash Light Intensity
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Violation:
The light intensity at the Steakhouse Bar and the Plaza Bar handwashing stations was less than 110 lux during normal lighting.
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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:
Food Service General-Light Intensity
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Violation:
The light intensity was less than 110 lux around and behind deck- and counter-mounted equipment in some areas, including: the equipment on the main galley beverage station near the forward service line, the juice machines on the Scarlett dining room upper level beverage stations, some of the equipment on the port and starboard Taste of Nations beverage stations, and some of the equipment on the room service pantry beverage station.
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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-Grand Buffet
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Violation:
The light intensity at the handwashing station was less than 220 lux.
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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.:
37
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Site:
Galley-Center Galley
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Violation:
There was condensate on the bulkhead behind the left tilting kettle. No food was impacted.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads.
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Item No.:
41
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Site:
Housekeeping-Passenger Public Toilets
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Violation:
There was no sign advising users to wash their hands at the handwashing stations.
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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.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The vessel had a draft copy of a new OPRP and staff stated it would be used if an outbreak occurred onboard. The draft copy did not include a concentration for Vital Oxide. The letters for informing passengers and crew of an outbreak and embarking passengers of a previous outbreak were indicated in the plan, but were not available to review. Also, the OPRP indicated a few locations where 1000 ppm of chlorine would be used in food areas or on food equipment.
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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: (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.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The vessel had a draft copy of a new OPRP and staff stated it would be used if an outbreak occurred onboard. The draft copy did not include a concentration for Vital Oxide. The letters for informing passengers and crew of an outbreak and embarking passengers of a previous outbreak were indicated in the plan, but were not available to review. Also, the OPRP indicated a few locations where 1000 ppm of chlorine would be used in food areas or on food equipment.
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Recommendation:
Ensure the concentration of chlorine sanitizing solution is between 50-200 ppm in food areas or on food equipment.
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Item No.:
42
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Site:
Children Area-Exclusion Policy
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Violation:
The posted exclusion policy for ill children did not include a requirement for written clearance from the medical staff before an ill child was allowed to return to the children's area.
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Recommendation:
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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