1.1 Health Canada Cruise Ship Inspection Program

Transcription

1 1.1 Health Canada Cruise Ship Inspection Program Background Through consultation with the cruise ship industry, Health Canada Workplace Health and Public Safety Program, has implemented a voluntary compliance inspection program of cruise ships that visit Canadian ports to prevent the introduction, transmission, and/or spread of communicable diseases into Canada. This proactive and collaborative approach between the cruise ship industry and Health Canada has been exemplified in the past by a high level of compliance from the cruise ship industry to Health Canada s guidelines In keeping with the harmonization process between the United States Centers for Disease Control and Prevention, Vessel Sanitation Program (CDC/VSP) and Health Canada Workplace Health and Public Safety Program (HC/WHPSP), HC/WHPSP has adopted the CDC/VSP administrative guidelines and technical criteria for inspections, with the required jurisdictional changes where necessary 1. Activities The Health Canada conducts: Unannounced comprehensive food safety and environmental sanitation inspection on vessels that have a foreign itinerary, call on a Canadian port, and carry 13 or more passengers. The definition of a cruise ship includes expedition vessels that travel in northern Canada. Ongoing surveillance of gastrointestinal illness and coordinates / conducts outbreak investigations on vessels. Other activities such as: investigating disease outbreaks; checking a specific condition such as halogen residual in the potable water distribution system; or investigating complaints of unsanitary conditions on a vessel. Furthermore, the program disseminates information to the public 2.

2 Authority The Minister of Health of Canada under the authority of Section 4(2) of the Department of Health Act, has powers, duties and functions relating to health including the following matters: the protection of the people of Canada against risks to health and the spreading of diseases the investigation and research into public health including the monitoring of diseases the protection of public health on railways, ships, aircraft, and all other methods of transportation, and their ancillary services In addition, the Quarantine Act (2005) authorizes the Minister of Health, or any person designated as an Environmental Health Officer (EHO) by the Minister under the Quarantine Act to board any conveyance arriving in Canada from a place outside of Canada or departing from Canada for a place outside of Canada and inspect that conveyance and any goods found therein for the purpose of preventing the introduction of communicable diseases into Canada 3. Operating procedures Gastrointestinal diseases surveillance Case definition A case definition of reportable gastrointestinal illness is defined as: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period); 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 38 C (100.4 F)); and (3) Reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member.

3 (4) Nausea, although a common symptom of gastrointestinal illness, is specifically excluded from this definition to avoid misclassifying seasickness (nausea and vomiting) as gastroenteritis. The reportable cases shall include those crew members with a symptom onset time of up to 3 days before boarding the vessel. Documentation of the 3 day assessment for each crew member WITH SYMPTOMS shall be maintained on the vessel and be available for review during inspections. These case definitions are to be used for identifying and classifying cases, both of which are done for reporting purposes. They should not be used as criteria for clinical intervention or public health action. For many conditions of public health importance, action to contain disease should be initiated as soon as a problem is identified; in many circumstances, appropriate public health action should be undertaken even though insufficient information is available to determine whether cases meet the case definition. Notification Gastrointestinal illness surveillance can be accomplished by ensuring that the ship s personnel follow these procedures: 1. Maintain a standard gastrointestinal illness log for each cruise which includes: all reportable cases, date and time of onset, age, name, sex, passenger or crew designation, cabin number, meal seating information and the first date of illness reported to the clinic. The log should be separate from the one used for all visits to the ship s physician (i.e., medical log). 2. Maintain a separate inventory of the daily total antidiarrheal medications sold or dispensed to the passengers or crew alongside the gastrointestinal illness log. 3. Encourage crew members with gastrointestinal illness to report their illness to the ship s physician. Reassign any ill crew member from the galley or food service area to another position until the crew member has been free of symptoms for at least 24 hours. 4. Encourage all medical personnel serving on board ship to be familiar with the common causes of foodborne and waterborne diseases, with the basic principles of epidemiology, and with techniques used to investigate illness aboard a vessel. Routine Reporting: A standard G.I. illness report is required to be submitted 24 hours before the vessel s arrival at a Canadian port. The report contains the name of the

4 vessel, ports and dates of embarkation and disembarkation, the total number of ill passengers and crew and the total number of passengers and crew. When a cruise does not originate in Canada, routine reporting is required 24 hours prior to arrival at the first Canadian port of call. When more than one port of call is scheduled in Canadian waters, routine reporting is also required 24 hours prior to arrival at the last Canadian port of call. When a cruise originates in Canada, routine reporting is required 24 hours prior to arrival at the last port of call in Canada 2. In addition to the reporting of gastrointestinal illness, Section 12 of the Quarantine Regulations requires that the person in charge (captain) of the vessel report to the nearest quarantine officer as soon as possible prior to arrival at its Canadian port of destination any details of deaths or illnesses onboard involving a fever of at least 38/C (100/F) for two or more days with a rash, jaundice or glandular swelling 2;3. Gastrointestinal diseases outbreak investigation An outbreak of gastrointestinal illness occurs aboard a vessel when the number of cases are in excess of expected levels for a given time period. When the cumulative proportion of reportable cases of gastrointestinal illness reaches 2% among passengers or 2% among crew, and the vessel is within 15 days of arrival at a U.S. Port, the vessel shall submit a special report to VSP. This provides an early opportunity for consultation to potentially avert more illness among passengers and crew members. In most instances, if less than 2% of the guests are exhibiting illness this will not lead to an investigation aboard the vessel, but will provide the opportunity to discuss and monitor illness patterns, and collaboratively develop intervention strategies. Under special circumstances, when an unusual gastrointestinal illness pattern or disease characteristic is found, an investigation may be conducted when the proportion of cases is less than 3%. These special circumstances may include a high incidence of illness in successive cruises, unusual severity of illnesses or complications, or a large number of persons reporting the illness over a brief period of time 2.

5 Inspections Every cruise ships traveling in Canadian waters that has a foreign itinerary and carries 13 or more passengers is subject to inspections and, when necessary, reinspection. The inspections are unannounced and conducted once per year during the cruise ship season which extends from April to the end of October. The definition of a cruise ship includes expedition vessels that travel in northern Canada. Charge Under the authority of the Department of Health Act and in consultation with the cruise ship industry, the fee for the provision of an inspection for the current sailing season, during daylight hours, seven days a week, is outlined in the HC/WHPSP (Table 1). This fee does not include a contingency amount in the case HC/WHPSP needs to provide outbreak investigation services in the event of an outbreak onboard a ship. The full costs arising from any outbreak investigation will be charged to the cruise line(s) involved in the outbreak. Table 1: Inspection charge of the Health Canada Cruise ship Inspection Program: Size/Cost Factor

6 ategory (GRT) C ategory FEE* 1.1.4

7 1.1.8 A nspe ction/ G Reinspe ction

8 S hips >60, xtra Large $ 8, $2, $ tons

9 S hips 30,001-60,000 tons arge $ 6, $1, $

10 S hips 15,001-30, edium $ 5, $1, $ tons

11 S hips 9,001-15, mall $ 5, $ $.1.31 tons

12 S hips 3,001-9, etite $ 2, $ $.1.37 tons

13 S hips < 3,001 tons xtra Small $ 1, $ $

14 O THER INSPECTI ONS $ *This amount does not include contingency fund. If required, the amount will be added at time of billing. Not sail recommendation If an imminent health hazard exists or similar imminent threats to public health are found aboard a vessel, HC/WHPSP may recommend that the ship not sail. When the inspector finds these conditions, he or she will immediately notify the Director, Public Health Bureau, HC/WHPSP who will then contact the Director General, HC/WHPSP. The Director General will make the final determination to recommend that a ship not sail. An imminent health hazard shall be determined to be, but not limited to, one of the following situations: 1. Free halogen residual in the potable water distribution system is less than 0.2 ppm and this deficiency is not corrected before the inspection ends; 2. Inadequate facilities for maintaining safe temperatures of potentially hazardous food; 3. Inadequate facilities for cleaning and sanitizing equipment; 4. Continuous problems with liquid and solid waste disposal, such as inoperative or overflowing toilets or shower stalls in passenger and crew cabins; 5. Infectious disease outbreak among passengers or crew, and where it is suspected that continuing normal operations may subject newly arriving passengers to disease. If HC/WHPSP recommends that a ship not sail, the agency will conduct a follow-up inspection as soon as possible, generally within 4 hours.

15 Scoring System The scoring system is based on 41 inspection items with a total value of 100 points. Inspection items are weighted according to their probability of increasing the risk of a gastrointestinal disease outbreak. Each deficiency will contribute a certain number of points, which will be deducted from 100 possible points. Publicity of the inspection results HC/WHPSP will publish scores obtained during inspections on HC/WHPSP cruise ship inspection program website: The information included will be the name of the ship, the company owner, the date of inspection, the numerical score achieved by each ship, and the region of inspection. If a ship's status is under review, that fact will be indicated until the issue has been resolved by the Director, Pubic Health Bureau, HC/WHPSP or until the ship has been reinspected and its status has been determined. Reports, including the statement of corrective action, will be released under the Access To Information Act. If a report is being completed under the review system, HC/WHPSP will indicate that fact on the interim report provided to the requester, and HC/WHPSP will send a final report to that requester when it is available. Re-inspection and Follow-Up Inspections A reinspection is a complete sanitation inspection performed on vessels that, on the previous inspection, scored 85 or less. Reinspections must be complete inspections so that the score assigned will accurately indicate sanitation conditions on the reinspection date. A reinspection must be requested by the cruise line company within 48 hours of the periodic inspection and will be subject to availability of Health Canada inspectors. The cruise line will be charged the full amount as for a periodic inspection. Furthermore, it will be the cruise line s responsibility to cover the costs of any additional travel that may be incurred by an inspector to catch up with the ship while it is in Canadian waters. Health Canada may lack the availability of inspectors at a port because of workload and the extensive geographical areas covered. A follow up inspection is a partial inspection to review the status of defective items identified during a previous periodic inspection or reinspection. A follow-up inspection

16 cannot be a substitute for a periodic inspection. Follow-up inspections may be needed to: a) resolve a contested inspection OR b) inspect deficient items that resulted in a recommendation to prohibit the ship from sailing. Sanitation issues covered 1. Potable Water Source Bunker and Production Potable Water System Halogenation Potable Water System Halogen Monitoring Microbiologic Monitoring Water Distribution System Protection 2. Swimming Pools and Whirlpool Spas Flow Through Seawater Swimming Pools Recirculation Swimming Pools Whirlpool Spas Safety 3. Food Safety Reserved Personnel Food Equipment and Utensils Ware washing Poisonous and Toxic Materials Facilities

17 4. Integrated Pest Management Integrated Pest Management Pest Control 5. Housekeeping Infection Control Procedures Air Systems Fountains, Humidifiers, and Showers 6. Child-Activity Centers Diaper Changing Toilets and Handwashing Cleaning and Disinfection Exclusions

18 Reference List (1) Centres for Disease Control and Prevention NCfEH. Vessel Sanitation Program Operations Manual. Atlanta: US Department of Health and Hunam Services, Public Health Service, Centres for Disease Control and Prevention; (2) Health Canada. Health Canada cruise ship inspection program operations Manual Ottawa: Workplace Health and Public Safety Programme, Public Health Bureau; (3) Health Canada. Cruise ship inspection program administrative guide. Ottawa: Workplace Health and Public Safety Programme, Public Health Bureau; 2004.