Research Approach and Methodology

1. Healthcare workers' risk and 2. Infection prevention and control needs: Study design and
setting

To fulfill specific objectives, a prospective investigation of all HCWs working in all
governmental university hospitals and the affiliated COVID-19 quarantine hospitals.

To date, the Ministry of Higher Education has dedicated quarantine hospitals at the following
governmental universities: Ain Shams, Cairo, Helwan, Alexandria, Mansoura, Assiut, Minia.
This list may be expanded in the future. The project will be pilot tested in Ain Shams
University, then extended to other universities subsequently.

Study population For the purpose of this study, HCWs are defined as all staff in the
governmental university hospitals involved in emergency and intensive care and in the
provision of care for COVID-19 patients in the affiliated COVID-19 quarantine hospitals.
These include those who have been present in the same area as the patient, as well as those
who may not have provided direct care to the patient, but who have had contact with the
patient's body fluids, potentially contaminated items or environmental surfaces. This
includes health care professionals, allied health workers, auxiliary health workers (e.g.
cleaning and laundry personnel, x-ray physicians and technicians, clerks, phlebotomists,
respiratory therapist, nutritionists, social workers, physical therapists, lab personnel,
cleaners, admission/reception clerks, patient transporters, catering staff etc.). Once a case
of COVID-19 has been identified in these hospitals, a list of all health care workers with
any exposure to COVID-19 patient will need to be drawn up.

Study tool and data collection For risk categorization of HCWs exposed to COVID-19 virus and
assessment of infection control needs, an online survey questionnaire will be administered to
all HCWs in the governmental university hospitals involved in emergency and intensive care
and in the provision of care for COVID-19 patients in the affiliated COVID-19 quarantine
hospitals.

The questionnaire will be adapted from the World Health Organization relevant protocols and
interim guidance. The sections of the questionnaire will cover:

1. Socio-demographic, background information including history of tobacco use, and
pre-existing medical conditions;

2. COVID-19 virus exposure risk assessment for community exposure;

3. COVID-19 virus exposure risk assessment for nosocomial exposure (i.e. contact and
possible exposure with the COVID-19 patients since the patient has been admitted to the
health care facility);

4. HCW interactions with COVID-19 patient information;

5. HCW activities performed on COVID-19 patient in health care facility;

6. HCW symptoms;

7. Adherence to infection prevention and control measures during health care interactions;

8. Adherence to infection prevention and control measures when performing
aerosol-generating procedures (e.g. tracheal intubation, nebulizer treatment, open
airway suctioning, collection of sputum, tracheotomy, bronchoscopy, cardiopulmonary
resuscitation, etc.); and

9. Accidents with biological material.

This online survey will be completed at baseline and at any future contact or possible
exposure with the COVID-19 patients since the patient has been admitted to the hospital.

Other forms will complement the data collected in the online survey questionnaire. The
complementary forms include:

- Laboratory form for specimen collection for screening and testing and the relevant
results

- Follow-up laboratory form for specimen collection for screening and testing and the
relevant results

- HCW symptom diary: Each HCW contact will be asked to record the presence or absence of
various signs or symptoms each day for up to 21 days after the administration of the
baseline questionnaire (minimum 14 days).

- Outcome form for follow up of HCWs who experience contact or possible exposure with the
COVID-19 patients since the patient has been admitted to the hospital.

- Health care facility infection prevention and control form: filled once at baseline for
each of the study hospitals.

These will be filled by HCWs, and dedicated teams and coordinators representing the hospital
infection control focal points and the hospital management at each of the study hospitals.
The forms will be electronically linked to the online survey for instant updates of HCW
information using an automatically generated unique serial study number for each HCW to be
used across all study forms.

3. Testing for COVID-19 among healthcare workers:

For confirmation of seroconversion, determination of the secondary-infection attack rate, and
the proportion of asymptomatic infection paired serological samples will be collected:

1. A baseline serum sample will be collected from all healthcare workers with any exposure
(regardless of symptoms), as soon as possible after confirmation of a COVED-19 infected
patient in the hospital.

2. A second serum sample will be collected from the same healthcare workers at least 21
days after the collection of the first serum sample

For measuring the validity of the available rapid serological tests:

A respiratory sample will be taken for viral detection by RT-PCR

4. Geospatial mapping of health care workers' risk and infection control needs:

To achieve this aim the following subtasks must be done:

- Build a full stack web-based platform that is integrated with a geographical information
system. Where, the platform frontend is a real-time interactive map.

Moreover, the platform backend is a database system to store and manipulate the HCWs' risk
and infection control data.

- Build a real-time Signal-R flagging service to track the survey results and put flags on
the platform interactive map where these flags represent the location of high HCWs' risk
and infection control rate.

- Build a real-time reporting service based on Signal-R and Artificial Intelligence
techniques to follow up the survey results and inform the policy and the decision makers
with the location and information of the high HCWs' risk and infection control rate.

Furthermore, this reporting service provides more insights on the survey results using the
Artificial Intelligence techniques such as the association between the geographical
information and the high HCWs' risk rate.