Infection prevention on cruise ship : A flowchart guide for maritime professionals

Abstract

A range of risk factors including the dense population in a confined space have been correlated to the risk of infections on cruise ships. With more people projected to take cruises, the need for evidence-based, comprehensive information about infection prevention onboard is important especially in the wake of newly and re-emerging infections. With specialist knowledge, nurses are pivotal in their public health role to assess and prevent illness in any setting through education and advice to increase awareness. As such, the objective of this thesis was to provide information for maritime professionals about common cruise infectious diseases and the best practices to minimize their onset and spread on cruise ships as evidenced through literature search and mapped into an easy-to-follow flowchart by autumn 2023.

To address the needs of the client while fostering flexibility, collaboration and open communication, an agile project method using plan-do-check-act (PDCA cycle) to implement the phases of the project was adapted throughout the project’s lifecycle. Relevant literature in English and Finnish were mainly retrieved from PubMed, SAMK Finna, Google Scholar, Duodecim Terveyskirjasto and scanning reference lists.

In Finland, respiratory, gastrointestinal, vaccine-preventable, vector-borne and skin infections are common on cruise ships. Taking into consideration the various modes of transmission, clinical manifestations, and corresponding general precautions - standard and transmissible measures including screening, vaccination or prophylaxis, safe food and water consumption, environmental hygiene, hand hygiene and isolation or quarantine were recommended in accordance with Finnish, EU and international standards. A flowchart guide using “draw.io” was created to enhance preventive efforts. Furthermore, the quality of the flowchart was pilot tested among the SAMK nursing students and adjustments made as necessary.

This project targets maritime professionals (crew and staff), but also beneficial to cruise passengers, owners, operators and nurses or nursing students interested in working on cruise ship or travel health. This study hopes to enhance their knowledge, influence behaviours and modification of cruise environment or operations to combat or minimize spread of infection onboard.