Interventions to prevent injuries in construction workers: Cochrane systematic review
Assessed as up to date: 2017/04/01
Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain.Objectives
To assess the effects of interventions for preventing injuries in construction workers.Search methods
We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews.Selection criteria
Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites.Data collection and analysis
Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention.Main results
Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.
Regulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).
Safety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).
We found no studies that had evaluated informational interventions alone such as campaigns for risk communication.
We found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.
Monetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).
A safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study).Authors' conclusions
The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.
van der Molen Henk F, Basnet Prativa, Hoonakker Peter LT, Lehtola Marika M, Lappalainen Jorma, Frings-Dresen Monique HW, Haslam Roger, Verbeek Jos H
Interventions to reduce injuries in construction workers
Occupational injury rates among construction workers are the highest among the major industries. While various organisations have proposed several injury control strategies, their effectiveness for reducing the rate of injuries in the construction industry remains uncertain.
What is the aim of this review?
To find out which interventions are most effective for reducing on-the-job injuries in construction workers.
We conducted a systematic search of the literature on preventing occupational injuries among construction workers. We included 17 studies in this updated review, rating the evidence as very low quality. Multifaceted interventions and company incentives for upgrading equipment may be effective in reducing injury. However, an evidence base is still needed for the vast majority of safety measures that safety manuals, consultants and safety courses routinely recommend.
What was studied in the review?
We looked at different types of workplace interventions, including the introduction of new regulations, safety campaigns, training, inspections, occupational health services, and company subsidies. We evaluated the quality of the studies and the effectiveness of interventions, rating the evidence as very low quality.
What are the main results of the review?
Introducing regulations alone may or may not be effective for preventing non-fatal and fatal injuries in construction workers. Regionally oriented interventions such as a safety campaigns, training, inspections or occupational health services may not be effective for reducing non-fatal injuries in construction workers. However, a multifaceted safety campaign and a multifaceted drug-free workplace programme at the company level, along with subsidies for replacement of scaffoldings, may be effective in reducing non-fatal injuries.
Additional strategies are needed to increase the employers' and workers' adherence to the safety measures that are prescribed by regulation.
How up-to-date is this review?
We searched for studies that had been published up to 1 April 2017.
Implications for practice
Based on the nine included regulatory studies, there is insufficient evidence for or against the effectiveness of regulations to reduce fatal and non-fatal injuries among construction workers. Nor is there sufficient evidence in the included studies that regionally oriented safety interventions such as campaigning, training, inspections or new occupational health services are effective for reducing non-fatal injuries in construction workers. There is a need for additional strategies to maximise the compliance of employers and workers to the safety measures as prescribed by regulation or advocated through regionally oriented interventions. Multifaceted and continuing interventions, such as a targeted safety campaigns at company level or a drug-free workplace programme, or safety standard and subsidy policy in case of high risk equipment, may be effective for reducing injuries in the longer term. Trying to influence the safety culture and the enforcement of the implementation of safety measures at worksites among management and construction workers is important. However, lack of evidence for safety interventions does not mean that these interventions do not work, but that better evaluation is necessary.
Implications for research
In the construction industry, more (preferably randomised) studies are needed to establish the effect of various safety interventions on fatal and non-fatal injuries. Studies with ITS over several years with a high internal validity and a correct statistical analysis are feasible when controlled studies are not possible. Regulatory ITS studies should give more attention to adherence to regulation and enforcement aspects, both during the intervention and in the evaluation phase.Get full text at The Cochrane Library
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