Sometimes on Cruise Ships, Shit Happens…

November 21st, 2009. By Hunter West

They fall all over themselves to make sure you have a good time. But they might not be doing the one thing that would pretty near guarantee you one:

 

Cleaning the public restrooms. And the problem with a gastrointestinal outbreak on a cruise ship is that you’re often thousands of miles in the middle of nowhere.

 

Make no mistake—compared to other bathrooms of the world, cruise ship bathrooms appear to be sparkling. I’ve been in them. So have you. And compared to the bathroom at the airport, or at the restaurant where you had dinner before your flight to meet the ship, cruise ship rest rooms appear to be so clean you could eat off the floor.

 

Well, almost. But not quite.

 

The problem is the pesky norovirus, which is a tough old bird that survives on just about anything for weeks at room temperature. And you know those alcohol-based hand sanitizers you see everywhere now? They won’t kill it. Bleach is the only thing that works.

 

You’re not going to walk around a cruise ship with a jar full of bleach in your pocket, so it behooves the people cleaning the bathrooms to do it for you.

 

However, a paper published earlier this month in Clinical Infectious Diseases (CID) suggested that thorough cleaning is not happening. Close, but no cigar. And the norovirus doesn’t much care if you smoke or not.

 

Researchers writing in the November 1st issue of CID reported that according to the Centers for Disease Control and Prevention (CDC) almost all of the 66 occasions where a gastrointestinal outbreak has occurred on a cruise ship since 2005 were caused by the pesky norovirus. Specifically the researchers looked at 19 outbreaks of gastrointestinal illness during their three-year study period.

 

They found that ships encountering outbreaks had restroom cleanliness scores that were only slightly lower than those ships having not encountered an outbreak.

 

Here’s an interesting sidebar: cruise ships that had outbreaks generally achieved high passing scores on the inspection closest to their outbreaks and—on average—their scores were higher than those of ships with passengers who had no episodes of gastrointestinal difficulty.

 

Again, close but no cigar. The authors of the study indicated that the difference was not statistically significant; but that the findings were consistent with the possibility that restroom contamination contributed to norovirus epidemics on cruise ships.

 

For the study, the researchers tested toilets on 56 cruise ships ranging in capacity from 1,258 to 3,600 passengers. Using an easily removable solution visible only under ultraviolet light, they marked the restroom door, toilet seats, flush handles, stall doors, handholds and baby-changing tables in 273 randomly selected public restrooms. They then monitored them for five to seven days to see if the solution had been removed by cleaning or disinfecting.

 

Four of the vessels had perfect or near-perfect scores: the restrooms were thoroughly cleaned nearly every day. But overall, only 37 percent of 8,344 objects were cleaned daily. Most of the ships had no baby-changing tables, but on three that did, none of them were cleaned at all during the study period.

 

These results were barely worse than that of acute-care hospitals, where a similar study published last year found that only 46.5 percent of objects in toilet areas were consistently cleaned.

 

Okay, so the cruise ships ranked barely worse than hospitals for cleanliness. And the norovirus is one, tough customer. But the difference between a gastrointestinal outbreak happening in a hospital and on a cruise ship is that in a hospital you’re at least on terra firma, as opposed to being not only miles from home but also miles from anywhere.

 

Cruise ships feature a contained population with a great deal of passenger interaction. You’re often out at sea in the middle of nowhere—and while all ships have appropriate medical facilities on board, a fast-moving outbreak can tax even the best medical staff and facilities.

 

And it’s a long way to a hospital, or to call for an ambulance.

 

It should be noted that, according to the authors of the study, a sanitation program run by the CDC fails to detect the dirty bathrooms—so any ship subscribing to it appears to being led down the garden path.

 

However at the end of the day, the very nature of cruising and the inherent environment—a ton of people, a contained environment, the potential for being days out at sea—should give pause for operators of cruise ships to make restroom cleanliness job one. They SHOULD be clean enough to eat off the floors. They SHOULD be cleaner than those found in hospitals. They should almost be sterile.

 

That’s what you want when you’re thousands of miles in the middle of nowhere. Because when an outbreak happens the only place to go is your cabin. You’re marooned on an island with thousands of potentially sick people.

 

And that’s a movie you don’t want to have a part in…

 

 

Tags: Cruise Ship, norovirus, outbreak

This was posted on Saturday, November 21st, 2009 at 9:20 am and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.