Interventions to prevent injuries in construction workers

  • Review
  • Intervention

Authors


Abstract

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

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.

Laienverständliche Zusammenfassung

Maßnahmen zur Reduzierung von Verletzungen bei Bauarbeitern

In der Industrie sind Arbeitsunfälle vor allem unter Bauarbeitern weit verbreitet. Verschiedene Organisationen haben unterschiedliche Strategien vorgeschlagen, wie das Verletzungsrisiko vermindert werden kann. Ob diese Maßnahmen die Verletzungsrate im Baugewerbe tatsächlich senken können, war bislang unklar.

Die wissenschaftliche Literatur wurde systematisch nach Studien durchsucht, in denen Maßnahmen zur Vorbeugung von Arbeitsunfällen bei Bauarbeitern untersucht wurden. Das Verzerrungspotenzial der Studien wurde bewertet und die Wirksamkeit der Maßnahmen zusammenfassend analysiert. Insgesamt wurden dreizehn Studien gefunden.

Mehrere Studien untersuchten die Einführung von Sicherheitsrichtlinien. Sie lieferten keine Belege dafür, dass diese Richtlinien alleine wirksam sind, um Verletzungen mit oder ohne Todesfolge bei Bauarbeitern vorzubeugen. Einzelne Studien untersuchten regional begrenzte Maßnahmen wie Sicherheitskampagnen, Schulungen, Arbeitsschutzbegehungen oder die Einführung von betrieblichen Gesundheitsdiensten. In diesen Studien gab es keine Belege dafür, dass solche Maßnahmen die Zahl nicht tödlicher Verletzungen unter Bauarbeitern wirksam senken können. Einzelne Studien lieferten schwache Hinweise auf die Wirksamkeit von zwei Maßnahmenpaketen: Eine mehrteilige Sicherheitskampagne und ein mehrteiliges betriebliches Programm zur Senkung des Drogen- und Alkoholkonsums am Arbeitsplatz schienen die Zahl nicht tödlicher Verletzungen wirksam senken zu können.

Zusammenfassend zeigt sich, dass die alleinige Einführung von Sicherheitsrichtlinien die Rate von Verletzungen mit oder ohne tödlichen Ausgang nicht wirksam senken kann. Es sind zusätzliche Maßnahmen erforderlich, um sicherzustellen, dass sich Arbeitgeber und -nehmer auch an die Sicherheitsvorschriften halten. Fortlaufende betriebliche Maßnahmen, die sich an Führungskräfte und Bauarbeiter richten, scheinen das Risiko von Verletzungen längerfristig senken zu können. Beispiele hierfür sind gezielte Sicherheitskampagnen sowie Programme für alkohol- und drogenfreie Arbeitsplätze.

Sicherheitsberater, Sicherheitsschulungen und die Literatur zur Arbeitssicherheit empfehlen unterschiedliche technische, personelle und organisatorische Maßnahmen zur Vorbeugung von Arbeitsunfällen. Für die meisten dieser Empfehlungen fehlt bisher eine wissenschaftliche Basis.

Anmerkungen zur Übersetzung

R. Büchter, Koordination durch Cochrane Schweiz

Laički sažetak

Intervencije za smanjivanje ozljeda građevinskih radnika

Stope ozljeda na radu kod građevinskih radnika su najviše među glavnim granama industrije. Iako je od strane različitih organizacija predloženo nekoliko strategija za smanjenje broja ozljeda, njihova učinkovitost za smanjenje stope ozljeda u građevinarstvu i dalje ostaje nejasna.

Provedeno je sustavno pretraživanje literature kako bi se pronašle studije u kojima su analizirani postupci za sprečavanje ozljeda na radu među građevinskim radnicima. Bio je procijenjen rizik od pristranosti u tim studijama i bila je ocijenjena učinkovitost intervencija. Pronađeno je 13 studija.

U tim studijama nije bilo dokaza da je samo uvođenje propisa učinkovito u sprečavanju nesmrtonosnih i smrtonosnih ozljeda kod građevinskih radnika. Nema dokaza da su intervencije koje se provode regionalno, kao što su kampanja o sigurnosti na poslu, edukacija, inspekcija ili uvođenje usluga medicine rada učinkovite u smanjenju nesmrtonosnih ozljeda kod građevinskih radnika. Ima dokaza niže kvalitete da su složene kampanje o sigurnosti i složeni programi za radno mjesto bez droge, kad se provode na razini tvrtke, učinkoviti u smanjivanju nesmrtonosnih ozljeda.

Samo uvođenje propisa nije bilo učinkovito u smanjivanju nesmrtonosnih i smrtonosnih ozljeda kod građevinskih radnika. Potrebne su dodatne strategije kako bi se potakli poslodavci i radnici da se pridržavaju sigurnosnih mjera propisanih zakonom. Čini se da kontinuirane intervencije koje su namijenjene tvrtkama, i koje se provode među članovima uprave i samim građevinskim radnicima, kao što su ciljana sigurnosna kampanja ili program radnog mjesta bez droge, imaju dugoročniji učinak u smanjivanju ozljeda.

Potrebni su dokazi iz novih istraživanja o velikom broju tehničkih i ljudskih faktora te o djelotvornosti organizacijskih postupaka koje preporučuju standardni tekstovi o sigurnosti, savjetnici i tečajevi o sigurnosti na radnom mjestu.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Ivana Sruk
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr