The cruise industry has always been at the forefront of disease prevention and control procedures and has undergone rigorous health inspections to certify this. It's essential to understand that the bar was already set very high before this pandemic severely impacted the customs and practices of even the most advanced civilizations.
Article from CruisesNews magazine no. 52 – June 2020
Two of the key elements in the quality of a cruise product are hygiene and cleanliness. Depending on the size of the ship, anywhere from hundreds to more than 6,000 people will share the space on board. And that space, that environment, inside the ship, is restricted, making human contact unavoidable, because socializing on a cruise is inevitable.
For this reason, it is not only advisable, but necessary to keep all areas of the ship spotless, from the cabins to the common areas. The health of passengers and crew members, as we have seen very recently, also depends on it. In the United States, this need is taken very seriously.
Embarking on a Clean Cruise Ship:
Onboard cruise ships, the presence of innovative leisure facilities and a comprehensive entertainment program can be compromised by poor hygiene. The cleanest cruise ships in the world are not necessarily the largest or most luxurious. Given the layout of the spaces on ships, cleaning is one of the most complex and important tasks onboard. It mobilizes a huge, practical, and meticulous team of staff. The scale of this task is even more significant on mega-cruise ships.
Day and night, the crew members work tirelessly to keep the cabins and all common areas—from lounges and pools to the theater and restaurants—clean and hygienic. During port calls, the cleaning team often takes advantage of the reduced passenger numbers to thoroughly clean the ship. Onboard, everything, from the floors to the windows, must be spotless and gleaming.
The shipowner is obliged to correct all defects or deviations.
During the crossing, crew members can also raise awareness among passengers, for example, to recycle correctly in the different containers, or to wash their hands properly.
The ships have an industrial laundry where sheets, towels, bathrobes, etc., are sanitized. This important cleaning operation is carried out continuously throughout the cruise.
Ship Construction and Refurbishment Project Requirements:
To achieve a clean and healthy ship, every detail must be carefully considered throughout the project. The VSP (Vessel Safety and Protection Service) acts as a consultant at the request of the cruise ship owner during the design phase, during construction, or during a major refurbishment. The VSP evaluates the ship's design, eliminates all health risks as deemed necessary, and incorporates the modifications required to create a healthy onboard environment. The VSP provides naval engineers with a reference manual, the "VSP Construction Guidelines," which outlines all the requirements the ship must meet.
The first manuals of requirements for the construction of cruise ships were published by the VSP in 1997 and 2001 under the title “Recommended Shipbuilding Construction Guidelines for Cruise Vessels Destined to Call on US Ports”. Since 2005, these reference manuals have been known as “VSP Construction Guidelines”.
The VSP typically conducts draft revisions for new vessels a minimum of 18 months before delivery. The time required for major refits is shorter. To allow time for implementing the necessary changes, the VSP coordinates project revisions well before the steel cutting, the first milestone in shipbuilding.
Typically, two VSP officers are assigned to the project and conduct a review at the technical office, where they meet with the shipowner, shipyard engineers, subcontractors, etc., who will be responsible for most of the subsequent work.
This review oversees everything related to the areas covered by the manual, including:
• Complete plans or drawings.
• Technical specifications and data sheets.
• Equipment specifications.
• General deck layout plans.
• Samples of any decorative materials used in food service areas and bars.
• All plans for food storage, preparation, and service areas.
• Level and type of food to be served (e.g., menu concept, etc.).
• Plans of potable and non-potable water systems with details of sea boxes, overboard discharge points, and non-return devices, etc.
• Ventilation system plans.
• Plans for all aquatic recreational facilities, such as slides and water parks.
• Portable cleaning equipment.
• Cabin crew work areas.
• Operating diagrams for all misting systems and decorative fountains.
Only through aggressive and continuous efforts by the industry to achieve and maintain high food safety and health standards is the implementation and success of a public health protection program on board viable.
After reviewing this vast amount of documentation, the VSP prepares a project review report summarizing the recommendations made during meetings, visits, etc., and sends the report to the shipyard and the shipowner's representatives
Following the plan review, the shipyard is obligated to implement all changes suggested by the VSP. After implementing these changes, the shipyard will provide any revised drawings or copies of any significant change orders issued after the review for review.
While the ship is being built, representatives of the shipyard, shipowner, or any other representative of the vessel may direct questions or requests to the VSP officials in charge of the project.
Compliance with these requirements is verified through an inspection of the vessel at the shipyard.
A ship inspection at the shipyard typically requires up to three officials, depending on the size of the vessel and whether it is the first in a series of newly designed ships. The inspection usually lasts a week and should be conducted approximately four to five weeks before the vessel's delivery, when the areas to be inspected are about 90% complete. The Vessel Safety Program (VSP) provides a written report to the requesting party. Before the ship arrives in the United States, the shipyard will submit a statement to the VSP detailing the corrections made to each item identified during the inspection.
For example, when Royal Caribbean decided in 2016 that Pullmantur's Empress would sail again from a North American port as Empress of the Seas, it had to undergo a lengthy refurbishment at Navantia Cádiz, which then had to be extended at the Grand Bahama Shipyard because the ship failed a VSP inspection on June 3, 2016, with a score of 80. Just one month later, on July 9, 2016, it passed with a score of 97, an excellent mark for a ship that was almost thirty years old.
Final Construction Inspection:
At the request of the shipowner or shipyard, VSP can conduct a final construction inspection, which will only be performed after construction is 100% complete and the cruise ship is fully operational. A full inspection of a vessel under construction over 140,000 GT costs $47,840.
These inspections are conducted to evaluate the corrections made in the previous review, assess all areas that were previously incomplete, and evaluate performance testing on systems that could not be tested. Such systems include the following:
• Ventilation of cooking, storage, and dishwashing areas.
• Dishwashing lines.
• Artificial lighting levels.
• Temperatures at refrigerated and heated tables.
• Chlorine levels and other chemical measurements for drinking water or recreational water systems.
This inspection must be requested a minimum of 10 days before the ship's arrival in the United States, although at the request of the shipowner, and provided that the ship does not enter the American market immediately, VSP can carry out final construction inspections outside the United States.
If a final construction inspection is not requested, the VSP will generally conduct a surprise inspection within four weeks of the ship's arrival in the United States.
Surprise Inspections in U.S. Ports:
Thanks to the Vessel Surveillance Program (VSP), U.S. authorities can inspect cruise ships at their home ports in Florida, California, Alaska, and other locations. A ship is required to undergo two surprise inspections annually, which assess its operational status and adherence to sanitary standards. If a ship sails outside the United States for an extended period, it will not be inspected twice a year, but it will be inspected again upon its return to the U.S.
Cleaning cruise ships is essential for the well-being and health of passengers.
The reference for these inspections is another manual, the “VSP Operations Manual.” Since 1986, the VSP program has been the responsibility of the National Center for Environmental Health (NCEH). At that time, the NCEH held a series of public meetings to determine the requests and needs of cruise passengers and the industry itself. On March 1, 1987, a structured program, as it operates today, began, and in 1988, the program went further by introducing a fee for cruise lines for inspections. This fee is based on the size of the vessel and is charged for both inspections and re-inspections. An inspection of a mega-ship over 140,000 GT, for example, costs $23,920.
The first VSP Operations Manual was published in 1989. By 1998, it was clear that the 1989 version needed updating due to legal changes and technological innovations, and a new edition was released in 2000, with input from the cruise industry. Further versions appeared in 2005 and 2011. And again, new technologies, as well as the emergence of new pathogens, necessitated updating the manual. Thus, the VSP Operations Manual 2018, currently in effect, was created.
There are no other references in the cruise industry. In 2007, "Guidance for the Management of Norovirus Infection in Cruise Ships" was published by the UK Health Protection Agency, in conjunction with the Passenger Shipping Association, the Maritime & Coastguard Agency, and the Association of Port Health Authorities, but it was not followed up.
At the end of the inspections, officials meet with the crew and provide a preliminary report outlining the vessel's hygienic condition, any defects found, and the inspection recommendations. VSP inspectors provide public health guidance to the crew when onboard standards are not met according to the VSP Operations Manual. Within two weeks, the VSP sends the final inspection report to the shipowner.
Fifteen ships have achieved a 100 out of 100 in the last year in VSP inspections at North American ports.
This report assigns a score between 0 and 100, based on criteria defined in the VSP Operations Manual. Each criterion is assigned a number of points; defects deduct points either when there is a pattern of similar violations of the same criterion, or when a single significant violation occurs, always taking into account its impact on public health. A score of 85 or less is unacceptable. All inspections, along with the score received, are published on the VSP website. When a vessel fails an inspection, it must undergo another one after a reasonable period of time.
The shipowner is obligated to correct all defects and violations. If any of these are critical to health on board, they must be corrected immediately or the vessel will not be allowed to sail. The Vessel Safety Board (VSP) has only once prohibited a vessel from sailing. This occurred in 2001 with the Arcadia, while it was operating in the Great Lakes.
The navigation ban, enforced by the Coast Guard Service, poses an imminent risk to public health for one or more of the following reasons:
• Inability to adequately chlorinate drinking water.
• Inability to maintain food at appropriate temperatures.
• Inadequate cleaning and sterilization facilities.
• Inability to properly manage solid and liquid waste.
Each vessel must submit a declaration outlining the corrective actions taken to remedy the defects. Some faults can be corrected during the inspection, but others may take considerable time to rectify.
The American VSP advises the shipowner, from the design stage and during construction, on how their ship should be from the point of view of hygiene and public health.
From 2000 to the present, 83 ships have failed VSP inspections with a score of 84 or lower. These include luxury lines (Silversea, Regent Seven Seas) and mainstream cruise lines (Carnival Cruise Lines, Royal Caribbean); megaships (like the QM2) and exploration vessels (Le Boreal), all of which have experienced the rigor of the VSP inspections. Conversely, fifteen ships have achieved a perfect score of 100 in the last twelve months: four from Royal Caribbean; two each from Viking Ocean, Celebrity Cruises, Holland America Line, and Disney Cruise Line; and one each from Carnival Cruise Lines, NCL, and Princess Cruises.
Currently, the VSP is working with shipping companies to implement a program for the prevention of gastrointestinal diseases on cruise ships by providing crew members with training in all aspects of hygiene.
Response to Gastrointestinal Illnesses on Cruise Ships:
If infection rates on a cruise ship rise above the limits described above, the Veterinary Surveillance Service (VSP) works with the crew and the shipowner's office to determine the cause of the outbreak. The first step is usually to request all records, including those related to gastrointestinal disease surveillance, and closely examine the information on reported cases. Surveillance records include information such as specific symptoms and the date and time the illness began.
By reviewing the records, the VSP can determine the following:
• Number of sick people on board the entire ship.
• Distribution of sick people among passengers and crew.
• Onset of illness.
• Distribution of illness during each day of the voyage.
• Symptom profile of those who are sick.
The objectives of an investigation are to determine the extent of the disease on board, identify the pathogen that causes it, identify the risk factors associated with the disease, and propose control measures to reduce or stop the spread of the epidemic.
During an outbreak, Vessel Safety Personnel (VSP) may even board the affected vessel to conduct an epidemiological assessment. This involves examining the distribution of gastrointestinal illnesses, interviewing passengers and crew, and distributing and analyzing questionnaires. They may also conduct an environmental health assessment, investigating specific areas on the vessel to verify both exposure and transmission routes of the disease, and to evaluate the procedures of the vessel's Epidemic Prevention and Response Plan. This assessment builds upon preliminary findings from the epidemiological review previously submitted by the crew. For example, if water is suspected as the source of the illness, the VSP pays closer attention to the review of the onboard water systems. Finally, they conduct a laboratory investigation to confirm the cause of the illness. Medical personnel may collect stool, vomit, or blood samples for submission to a shore-based laboratory.
During an epidemic, shipping companies must activate their Outbreak Contingency Plans and do everything possible to control it. These plans outline critical indicators and levels at which the ship's response to an outbreak must begin, including detailed infection control procedures for each area of the ship.
Measures taken on board typically include the following:
• Increased daily cleaning and disinfection frequency.
• Suspension of high-risk activities for contagion, such as buffets, self-service, etc.
• Isolation of sick individuals.
• Collection of clinical and/or environmental samples for analysis.
• Daily reporting to the Vessel Safety Program (VSP) with case counts and reports on the ship's control measures.
• Alerting passengers and crew about the disease.
• Providing training on proper handwashing techniques.
• Notifying new passengers about the outbreak before boarding.
In the event of an epidemic, the VSP may order hygiene and sanitation measures not only on the ship, but also in terminals and ports in coordination with the Port Authorities.
The VSP can also request that cruise lines notify Port Authorities of the situation on board, delay the embarkation of new passengers, and establish cleaning and disinfection procedures at cruise terminals. If the situation is serious, it can even prevent the next cruise, as happened with the Freedom of the Seas in December 2006.
Finally, the VSP trains cruise ship crews in the hygiene and sanitation practices described in the VSP Operations Manual.
The United States leads the way in cruise ship hygiene control.
But this isn't about appearances or image. Onboard hygiene should be a matter of reason, not faith. To monitor and evaluate the hygiene of cruise ships departing from U.S. ports, American authorities created a cruise ship inspection program. In 1975, the Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) in the United States as a cooperative program with the cruise industry, with the goal of improving onboard hygiene.
This program helps the cruise industry fulfill its responsibility to develop and implement comprehensive systems to protect passenger health, always based on objective criteria, on performance, not on feelings or perceptions.
The CDC program encourages cooperation between the cruise industry and the U.S. government to define and reduce health risks associated with ships, and to ensure a healthy and clean environment for passengers and crew on board.
Not all cruise ships are under the jurisdiction of the VSP program. Only those ships that carry thirteen or more passengers and offer an itinerary from a North American homeport are under VSP jurisdiction.
Epidemic Control on Board:
Another of VSP's functions is the control of epidemics on board, especially those of viral origin, which to date have resulted in mild consequences such as diarrhea, vomiting, etc. All ships departing from an American port are required to report any epidemic on board, and when it affects more than 2% of the passengers or more than 3% of the crew during an international itinerary ending within fifteen days in an American port. In practice, this means, for example, that all US-based cruise ships returning from the Mediterranean or Northern Europe after the summer season are obligated to inform US authorities of any outbreak on board before beginning their transatlantic voyage.
The hygienic and sanitary conditions of all cruise ships based in North American ports are evaluated on-site twice a year.
The epidemic surveillance log must include all segments from the start of the voyage, unless 67% (two-thirds) or more of the passengers disembark on any one segment. For cruises lasting more than 15 days before returning to the U.S., the 2% or 3% infection log must include all cases for the entire voyage. For example, on a round-the-world cruise departing from a U.S. port (the vast majority), the ship must maintain a VSP log even if it sails in, say, Australia or South Africa.
VSP may also prevent a ship from sailing during an outbreak or infection on board when continuing with normal operations could mean spreading the disease to newly arrived passengers.
