Intervention Review

Interventions to prevent injuries in construction workers

  1. Henk F van der Molen1,*,
  2. Marika M Lehtola2,
  3. Jorma Lappalainen3,
  4. Peter LT Hoonakker4,
  5. Hongwei Hsiao5,
  6. Roger Haslam6,
  7. Andrew R Hale7,
  8. Monique HW Frings-Dresen8,
  9. Jos H Verbeek9

Editorial Group: Cochrane Injuries Group

Published Online: 12 DEC 2012

Assessed as up-to-date: 1 SEP 2011

DOI: 10.1002/14651858.CD006251.pub3

How to Cite

van der Molen HF, Lehtola MM, Lappalainen J, Hoonakker PLT, Hsiao H, Haslam R, Hale AR, Frings-Dresen MHW, Verbeek JH. Interventions to prevent injuries in construction workers. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006251. DOI: 10.1002/14651858.CD006251.pub3.

Author Information

  1. 1

    Academic Medical Center, Coronel Institute of Occupational Health, Amsterdam, Netherlands

  2. 2

    Finnish Institute of Occupational Health, Promotion of Occupational Safety, Kuopio, Finland

  3. 3

    Finnish Institute of Occupational Health, Occupational Safety Team, Tampere, Finland

  4. 4

    University of Wisconsin, Madison, Center for Quality and Productivity Improvement, Madison, WI, USA

  5. 5

    National Institute for Occupational Safety and Health (NIOSH), Protective Technology Branch, Morgantown, WV, USA

  6. 6

    Loughborough University, Loughborough Design School, Leicestershire, UK

  7. 7

    Delft University of Technology, Safety Science Group, Delft, Netherlands

  8. 8

    Academic Medical Centre, Coronel Institute of Occupational Health, Amsterdam, Netherlands

  9. 9

    Finnish Institute of Occupational Health, Cochrane Occupational Safety and Health Review Group, Kuopio, Finland

*Henk F van der Molen, Coronel Institute of Occupational Health, Academic Medical Center, P.O. Box 22700, Amsterdam, 1100 DE, Netherlands. h.f.vandermolen@amc.nl. vandermolen@arbouw.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 12 DEC 2012

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Construction workers are frequently exposed to various types of injury-inducing hazards. A number of injury prevention interventions have been proposed, yet their effectiveness is uncertain.

Objectives

To assess the effects of interventions to prevent injuries in construction workers.

Search methods

We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, OSH-ROM (including NIOSHTIC and HSELINE), Scopus, Web of Science and EI Compendex to September 2011. The searches were not restricted by language or publication status. The reference lists of relevant papers and reviews were also searched.

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 study quality. For ITS, 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

Thirteen studies, 12 ITS and one CBA study met the inclusion criteria. The ITS evaluated the effects of the introduction or change of regulations (N = 7), a safety campaign (N = 2), a drug-free workplace programme (N = 1), a training programme (N = 1), and safety inspections (N = 1) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance.

The overall risk of bias among 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.

The regulatory interventions at national or branch level showed a small but significant initial and sustained increase in fatal (effect sizes of 0.79; 95% confidence interval (CI) 0.00 to 1.58) and non-fatal injuries (effect size 0.23; 95% CI 0.03 to 0.43).

The safety campaign intervention resulted in a decrease in injuries at the company level but an increase at the regional level. Training interventions, inspections or the introduction of occupational health services did not result in a significant reduction of non-fatal injuries in single studies.

A multifaceted drug-free workplace programme at the company level reduced 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 per year (95% CI -3.5 to -0.5).

Authors' conclusions

The vast majority of technical, human and organisational interventions that are recommended by standard texts of safety, consultants and safety courses have not been adequately evaluated. There is no evidence that introducing regulations for reducing fatal and non-fatal injuries are effective as such. There is neither evidence that regionally oriented safety campaigns, training, inspections nor the introduction of occupational health services are effective at reducing non-fatal injuries in construction companies. There is low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign and a multifaceted drug workplace programme can reduce non-fatal injuries among construction workers. Additional strategies are needed to increase the compliance of employers and workers to the safety measures that are prescribed by regulation. Continuing company-oriented interventions among management and construction workers, such as a targeted safety campaign or a drug-free workplace programme, seem to have an effect in reducing injuries in the longer term.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Interventions to reduce injuries in construction workers

Occupational injury rates among construction workers are the highest among the major industries. While several injury control strategies have been proposed by various organisations, their effectiveness for reducing the rate of injuries in the construction industry remains uncertain.

A systematic search of the literature was conducted on preventing occupational injuries among construction workers. The risk of bias of the studies was assessed and the effectiveness of interventions was evaluated. Thirteen studies were identified.

In these studies, there is no evidence that introducing regulation alone is effective in preventing non-fatal and fatal injuries in construction workers. There is no evidence that regionally oriented interventions such as a safety campaign, training, inspections or the introduction of occupational health services are effective in reducing non-fatal injuries in construction workers. There is low-quality evidence that a multifaceted safety campaign and a multifaceted drug-free workplace programme at the company level are effective in reducing non-fatal injuries.

Introducing regulation alone is not effective in reducing non-fatal and fatal injuries in construction workers. Additional strategies are needed to increase the compliance of employers and workers to the safety measures that are prescribed by regulation. Continuing company-oriented interventions among management and construction workers, such as a targeted safety campaign or a drug-free workplace programme, seem to have an effect in reducing injuries in the longer term.

An evidence base is needed for the vast majority of technical, human factors and organisational interventions that are recommended by standard texts of safety, consultants and safety courses.