Open Access Open Badges Research article

Hygiene inspections on passenger ships in Europe - an overview

Varvara A Mouchtouri1, Sandra Westacott2, Gordon Nichols3, Tobias Riemer4, Mel Skipp5, Christopher LR Bartlett6, Jenny Kremastinou7, Christos Hadjichristodoulou1* and the SHIPSAN partnership**

Author Affiliations

1 Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece

2 Association of Port Health Authorities, Southampton Port Health Authority, London, UK

3 Gastrointestinal, Emerging and Zoonotic Infections Department Health Protection Agency, Centre for Infections, London, UK

4 Hamburg Port Health Center, Institute of Occupational and Maritime Medicine, Hamburg, Germany

5 European Cruise Council and Cruise Line International Association

6 University College London, Centre for Infectious Disease Epidemiology Department of Primary Care and Population Sciences Royal Free and University College Medical School, London, UK

7 Department of Public and Administrative Health, National School of Public Health, Athens, Greece

For all author emails, please log on.

BMC Public Health 2010, 10:122  doi:10.1186/1471-2458-10-122

Published: 10 March 2010



Hygiene inspections on passenger ships are important for the prevention of communicable diseases. The European Union (EU) countries conduct hygiene inspections on passenger ships in order to ensure that appropriate measures have been taken to eliminate potential sources of contamination which could lead to the spread of communicable diseases. This study was implemented within the framework of the EU SHIPSAN project and it investigates the legislation applied and practices of hygiene inspections of passenger ships in the EU Member States (MS) and European Free Trade Association countries.


Two questionnaires were composed and disseminated to 28 countries. A total of 92 questionnaires were completed by competent authorities responsible for hygiene inspections (n = 48) and the creation of legislation (n = 44); response rates were 96%, and 75.9%, respectively.


Out of the 48 responding authorities responsible for hygiene inspections, a routine programme was used by 19 (39.6%) of these to conduct inspections of ships on national voyages and by 26 (54.2%) for ships on international voyages. Standardised inspection forms are used by 59.1% of the authorities. A scoring inspection system is applied by five (11.6%) of the 43 responding authorities. Environmental sampling is conducted by 84.1% of the authorities (37 out of 44). The inspection results are collected and analysed by 54.5% (24 out of 44) of the authorities, while 9 authorities (20.5%) declared that they publish the results. Inspections are conducted during outbreak investigations by 75% and 70.8% of the authorities, on ships on national and international voyages, respectively. A total of 31 (64.6%) and 39 (81.3%) authorities conducted inspections during complaint investigations on ships on international and on national voyages, respectively. Port-to-port communication between the national port authorities was reported by 35.4% (17 out of 48) of the responding authorities and 20.8% (10 out of 48) of the port authorities of other countries.


This study revealed a diversity of approaches and practices in the conduct of inspections, differences in the qualifications/knowledge/experience of inspectors, the legislation applied during inspections, and the lack of communication and training among many EU countries. An integrated European inspection programme involving competent expert inspectors in each EU Member States and special training for ship hygiene delivered to crew members and inspectors would help to minimize the risk of communicable diseases. Common inspection tools at a European level for hygiene inspection practices and port-to-port communication are needed.