Table 7 Transmission of SARS-Co-V-2 risks and relevant preventative measures

Transportation to study site by driver employed for the study and using study car

1. Driver

2. Uninfected participants using vehicle after infected participant

Risk of transfer of virus from infected participant’s bodily fluids, directly or via clothing, hands, bags etc. to vehicle surfaces, which may be transferred to next user

Risk of droplet transmission in vehicle

1. All participants to clean hands with alcohol-based sanitiser prior to entry into vehicle

2. All participants to wear surgical mask during travel

3. Driver to always wear N95 mask and face-shield

4. Fitted transparent impermeable divider between driver and participant; participant to sit in the rear passenger seats of vehicle

5. Driver to clean door handles, seats, and other surfaces in vehicle as far as possible with alcohol-based disinfectant or 0.5% bleach solution directly after infected participant exits vehicle

6. No physical contact between driver and participant

7. Only one participant to be transported at a time, unless both participants are known to be SARS-CoV-2 positive and from the same household, or if they recently tested negative for SARS-Co-V-2 and have no symptoms

8. SARS-CoV-2 positive participants only to be transported in vehicles reserved for this purpose

Transfer from vehicle to waiting area

1. Uninfected participants

2. Passers-by, campus staff and students

Risk of transmission when infected participant encounters uninfected person, viral transmission on clothing, hands and droplets spread

1. Ensure dedicated ‘COVID-19 corridor for infected participants to move from vehicle, through dedicated entrance/exit to waiting area; out of dedicated entrance/exit from waiting area to vehicle; movement within trial site to be restricted to COVID-19-dedicated areas

2. All participants to wear surgical masks and practice social distancing, drivers escorting participants will ensure they do not stop en route to the waiting area; opportunities to interact with others minimised by use of the dedicated SARS-CoV-2 waiting areas, consultation rooms and corridors

Waiting area

1. Uninfected participants in waiting area at the same time as infected participants

2. Uninfected participants who sit in chairs or touch surfaces used by infected participants after they have left the area

Risk of transmission from infected participants to uninfected participants from chairs and other surfaces, and expectorated droplets

1. Separate waiting area reserved for infected participants, with minimal furnishings, all of which are amenable to washing with disinfectant

2. Four times daily disinfecting of surfaces in waiting area (including floors, walls, tables, and chairs) with alcohol-based disinfectant or 0.5% bleach solution

3. Participants to always wear surgical masks

Consultation rooms

1. Study nurses, nurse’s assistants, clinicians

2. Uninfected participants using consultation rooms after infected participants

Risk of droplet transmission

Risk of transmission from surfaces and chairs

1. Dedicated consultation rooms for infected participants, uncluttered with only necessary stationery and equipment

2. Consultation rooms’ surfaces and chairs disinfected after each consultation with alcohol-based sanitiser or 0.5% bleach solution

3. Equipment (blood pressure cuff, thermometer etc.) wiped with alcohol-based sanitiser after each use

4. Study staff to wear surgical masks, face-shield or goggles, plastic aprons, and non-sterile gloves for the duration of the consultation. Gloves to be discarded and hands washed with alcohol-based disinfectant between participant encounters. Goggles and face-shields to be soaked in a bucket of disinfectant for 30 min at the end of a day. Aprons to be discarded on exiting the consultation room. Recommended donning and doffing procedures will be followed

5. Mobile perspex screens to be placed on desks in consultation rooms between participants and staff members

Bronchoscopy suite

1. Bronchoscopy clinical staff including endoscopist/pulmonologist, seditionist, bronchoscopy nurse, nursing assistant

2.Laboratory staff who collect specimens

3. Other participants waiting in recovery area

Risk of airborne transmission from particle aerosols during bronchoscopy

Risk of transmission from surfaces

Risk of droplet transmission from coughing post procedure

1. The bronchoscopy suite is equipped with an advanced ventilation system which provides a full air change every 5 min, fully extracting any aerosolised infectious particles

2. During the procedure every member of the clinical and laboratory team will wear the following PPE: a gown/single use laboratory coat (to be removed and discarded/washed after each procedure); a Powered Air Purifying Respirator (PAPR, which provides continuous N99-equivalent filtered air and full-face protection to the wearer); disposable gloves. If a PAPR is unavailable, then a combination of N95 and eye protection will be worn

3. Only the essential staff for the procedure will be allowed in the suite during the procedure and for 5 min afterwards

4. Doors between the suite and recovery room will be closed during the procedure and for 5 min afterwards to allow for a full air change in that area

5. The participant will don a surgical mask as soon as the bronchoscope is removed from their airway and continue to wear it throughout recovery

6. Participants who are waiting for their procedure will only enter the recovery area if it is empty of recovering participants (who may cough post-procedure)

7. All surfaces will be wiped/sprayed with sanitising solution after each procedure, and the whole suite will undergo daily wash with soap and water

Sample collection booth

1. Uninfected participants using the booth after infected participants

2. Staff who enter the booth

Risk of airborne transmission from particle aerosols

Risk of transmission from surfaces

1. Dedicated sample collection booth for high-risk participants; separate collection booths to be used by uninfected participants

2. Sample booth to be fully disinfected twice daily, including walls, floors, and all surfaces, with alcohol-based disinfectant or 0.5% bleach solution

3. Staff members present for the sample collection process will wear N95 face masks, face shields or goggles, disposable gowns (with full sleeves) and non-sterile gloves. Masks, gloves, and gowns will be doffed and disposed after every use; shields and goggles will soak for 30 min in disinfectant solution before the next use. Recommended donning and doffing procedures will be followed

Participant bathrooms

1. Uninfected participants

Risk of transmission from aerosolised particles and from surfaces in the bathroom

1. Dedicated bathroom for SARS-Co-V 2 infected participants only

2. Surfaces to be cleaned and disinfected twice per day with alcohol-based disinfectant or 0.5% bleach solution

3. Adequate ventilation (> 15 air exchanged per hour) ensured in bathrooms

All participant and clinical areas

1. Cleaning staff

Risk of transmission from surfaces and via airborne droplets

1. Cleaning staff to wear a surgical mask, plastic apron, long rubber utility cleaning gloves (ideally up to elbow) that can be washed, goggles or face shield, closed work shoes

2. Cleaning staff to enter and clear participant areas only after 30 min or more have elapsed since a participant was in the area

Sample transport from consultation rooms, sample collection booth, to the laboratory

1. Drivers

2. Sample transporters

Risk of transmission from surface of sample container and bag

1. Sample runner and driver to wear non-sterile gloves which are discarded after single use, and clean hands with alcohol-based disinfectant after removing gloves

2. Samples to be double bagged after collection, and transported in sealed temperature-controlled container