crown princess boarding delayed 4-18??

[RDC1]

Whatever the source, the Crown seems more vulnerable than the other ships, and to defy Princess's rather strenuous efforts to do something about it.

 

Could be the locations, type of cruises, etc.

 

Bottom line is this is now peak Noro time in North America (March/April)

 

Last year one of the outbreaks on the Crown happened during a long cruise that included the southern hemisphere during peak time there (September/October) with the outbreak occurring on the way back.

[VibeGuy]

Not necessarily. While the paper did show a reduction with some of the products, it is far from certain if the reduction is sufficient to make an impact on the spread. The paper itself raised that question and indicated that study would need to be done to determine that.

 

Since it only takes a very few viruses to successfully infect someone, even an 85% reduction, still leaves 15% to infect.

 

Um, I have to assume that by "85%", you mean the .85 in the results table next to the 3.75 log reduction.

 

Without bemoaning the state of numeracy in the world today, that was the standard deviation in the log reduction, meaning that most of the results came in between 2.9 log and 4.6 log.

 

This means that VF481 doesn't kill 85% of virus (which would be slightly less than 1 log reduction), but rather kills between 99.8 and 99.993% of the virus, and the variation between samples is inside that range.

 

There is an excellent, very readable discussion of this at http://www.antimicrobialtestlaboratories.com/log_reduction_and_percent_reduction_calculations.htm

 

Four-log reduction in 15 seconds is absolutely an effective control level. That's why VF481 replaced 447 - it's ten times more effective, and why 447 replaced classic formula Purell - 447 was 100x better and 481 is thus nearly 1000x better.

 

The trope that alcohol gels don't work is wrong. The *right* alcohol gels provide reliable protection and reduce hand-to-surface-to-hand spread of Noro.

[RDC1]

Um, I have to assume that by "85%", you mean the .85 in the results table next to the 3.75 log reduction.

 

Without bemoaning the state of numeracy in the world today, that was the standard deviation in the log reduction, meaning that most of the results came in between 2.9 log and 4.6 log.

 

This means that VF481 doesn't kill 85% of virus (which would be slightly less than 1 log reduction), but rather kills between 99.8 and 99.993% of the virus, and the variation between samples is inside that range.

 

There is an excellent, very readable discussion of this at http://www.antimicrobialtestlaboratories.com/log_reduction_and_percent_reduction_calculations.htm

 

Four-log reduction in 15 seconds is absolutely an effective control level. That's why VF481 replaced 447 - it's ten times more effective, and why 447 replaced classic formula Purell - 447 was 100x better and 481 is thus nearly 1000x better.

 

The trope that alcohol gels don't work is wrong. The *right* alcohol gels provide reliable protection and reduce hand-to-surface-to-hand spread of Noro.

 

yes I misread the table when I glanced over it. However, the paper itself still does raise the question about if the results will demonstrate improvements in transfer and indicates that more real world tests are needed.

 

Most sources in the US, including CDC still indicate that the most effective method for control is hand washing, not fluid based sanitizers. As indicated on their web site

 

Alcohol-based hand sanitizers can be used in addition to hand washing. But, they should not be used as a substitute for washing with soap and water. See “Handwashing: Clean Hands Save Lives.”

 

 

Most of the papers on Pubmed lean towards sanitizers to be used in conjuction with handwashing, not as a replacement for it. That when it comes to viruses that both methods need to be combined. Could not find any paper that indicated that liquid sanitizers without handwashing was considered to be good practice.

 

For example

 

J Food Prot. 2012 Jul;75(7):1303-9. doi: 10.4315/0362-028X.JFP-11-449.

Hand hygiene regimens for the reduction of risk in food service environments.

Edmonds SL1, McCormack RR, Zhou SS, Macinga DR, Fricker CM.

 

When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the 70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms.

[VibeGuy]

So handwashing alone - 3 log. VF481, 3.75 log. If log reductions correlate to transmission rates (as they do for other non-enveloped viruses), it's at least fair to say the two are comparable. That's very different than the widely-spouted CC wisdom that hand sanitizer does nothing.

 

Handwashing is clearly an important part of the equation, along with surface sanitization and use of food-code-compliant gels. If nothing else, ABHRs at the buffet entrances reduce viral contamination of the serving utensils more than doing nothing would.

 

I'm starting to wonder if the smart money is on two applications of sanitizer after washing; the one at the buffet entrance reduces the likelihood that the user deposits virus onto service items; one after passing through the buffet but before handling food or silverware might be more effective at keeping the user healthy.

[RDC1]

So handwashing alone - 3 log. VF481, 3.75 log. If log reductions correlate to transmission rates (as they do for other non-enveloped viruses), it's at least fair to say the two are comparable. That's very different than the widely-spouted CC wisdom that hand sanitizer does nothing.

 

Handwashing is clearly an important part of the equation, along with surface sanitization and use of food-code-compliant gels. If nothing else, ABHRs at the buffet entrances reduce viral contamination of the serving utensils more than doing nothing would.

 

I'm starting to wonder if the smart money is on two applications of sanitizer after washing; the one at the buffet entrance reduces the likelihood that the user deposits virus onto service items; one after passing through the buffet but before handling food or silverware might be more effective at keeping the user healthy.

 

The one major difference between the two procedures is that the primary method for reduction with hand washing is removal, where as a sanitizers primary mode is deactivation. Which raises the question of will over dependence on sanitizers end up with strains that are more resistant to them.

 

Hospitals have certainly encountered that situation with a number of other viruses and bacterial infections. One paper even indicated that soap and alcohol dispensers were active reservoirs of NoV (due to physical contact, not the internal contents)

 

I don't have an disagreement that sanitizers can help, but I would not agree that they offer a complete solution or should even be the primary mechanism. Handwashing is still preferred due to its mechanism of action (removal vs deactivation). Deactivating what remains with a sanitizer certainly doesn't hurt.

Edited April 20, 2015 by RDC1

[VibeGuy]

Healthcare and foodservice hand hygiene are not exactly the same problem. Non-enveloped viruses are the big issue in food safety, and it's usually bacteria that are a bigger problem in healthcare. Noro is a tougher nut to crack since you can't target the cell membrane (bacteria) or the lipophilic envelope (other viruses).

 

The dispensers Princess uses are non-contact so I'm not worried about cross-contamination. I think even the dispense nozzle is replaced when the bag is replaced.

 

I'm no germophobe - in fact, I'm immune to the most common Noro infections ($99 worth of genetic testing can identify if someone has the lucky genotype), but there are clearly factors in cruise ships that seem to exacerbate the rates of GI illness.

 

I am really not crazy about the boarding sequence from a critical control point standpoint: it starts with many people having flown (high-touch environment with opportunities for fecal contamination and limited ability to use oxidizing disinfectants due to corrosion risk), then puts them into shared rides with touch surface issues, then follows them into the terminal where they use shared pencils, to shared counters. Once they get on, a huge % hit the buffet without a stop for really effective handwashing.

 

Were I the medical officer, I would have to wonder if there might be three missed opportunities to keep my nice clean ship from getting contaminated by new cruisers:

 

1) mandatory boosted sanitizer at the door of the terminal at every port

2) single-use pencils for the health forms

3) mandatory boosted sanitizer at the gangway every boarding (not just port calls)

 

It's obvious that otherwise following the guidance isn't solving the problem. Fear of GI illness is among the top reasons people haven't taken cruise vacations, so it really behooves the industry to get out in front of the minimum levels of CDC/USPHS VSP recs.

[PescadoAmarillo]

The Crown is in drydock the beginning of May. Hopefully it can get a super deep clean and rid it of its Noro issues.

 

Unfortunately, sometimes the opposite occurs. When the Emerald Princess was dry docked in Freeport in 2012, the crew was given some time off and frequented bars and eating establishments that might not have had the best sanitary conditions. Plus the hundreds of contractors that come on board also bring germs at the same time noro reduction practices in place with passengers are not utilized. The ship came back after dry dock and immediately went on Code Red, with several crew members affected.

[marcyjane]

I'm just off the Crown from 4-11 to 4-18. If I recall correctly, there were about 25 people who were symptomatic. Definitely not a large amount, but enough to stop the buffet from being self-serve and crewmembers reminding everyone to wash their hands.

 

That is correct the Captain came on and told us that. Only 4 reported on our cruise and I was "NOT" one of those. Had a sick free cruise.:)

[karatemom2]

That is correct the Captain came on and told us that. Only 4 reported on our cruise and I was "NOT" one of those. Had a sick free cruise.:)

 

I'm glad the number stayed low, but I would point out that based on our experience not every case is documented. In order to log it for the CDC you are sent a document to complete and return. I'm not exaggerating when I say that the document is about 15 pages and requires extensive information on every activity, food, excursion, and ship area you have spent time on in the days prior to becoming ill. It would be quite onerous to complete even if you were feeling well, but while feeling ill it is basically the last thing on your mind. In our instance I completed it for my husband as best as possible so his case was documented. However, when my daughter and I got ill we never got the document delivered for our completion, even though we reported our illness. We were on the final day of the cruise and exited the next morning with really no follow up at all. So I know for sure that out of the three cases in our cabin only one was documented. And my son got sick the day we got home, so his was not documented either.

 

I'm not saying the numbers on your cruise were extensive, however, I would bet they were definitely higher than what was being reported.

[MauiLvrs]

The only that kills Noro is bleach and washing with soap and water for 2 minutes . This information that my Doctor and Registered Nurses supplied to our family.

 

Washing with plain soap and water doesn't kill it ... it only washes most of it away.