Get access

Alcohol and drug screening of occupational drivers for preventing injury

  • Review
  • Intervention

Authors

  • Clodagh M Cashman,

    Corresponding author
    1. Medical Council, Research Department, Dublin, Ireland
    • Clodagh M Cashman, Research Department, Medical Council, Lynn House Lower Rathmines Road, Dublin, 6, Ireland. clodaghcashman@hotmail.com.

    Search for more papers by this author
  • Jani H Ruotsalainen,

    1. Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland
    Search for more papers by this author
  • Birgit A Greiner,

    1. University College Cork, Department of Epidemiology and Public Health, Cork, Ireland
    Search for more papers by this author
  • Paul V Beirne,

    1. University College Cork, Department of Epidemiology and Public Health, Cork, Ireland
    Search for more papers by this author
  • Jos H Verbeek

    1. Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland
    Search for more papers by this author

Abstract

Background

Workforce alcohol and drug testing is commonplace but its effect in reducing occupational injuries remains unclear.

Objectives

To assess the effects of alcohol and drug screening of occupational drivers (operating a motorised vehicle) in preventing injury or work-related effects such as sickness absence related to injury.

Search methods

We searched the following databases up to June 2007 (or up to the latest issue then available): MEDLINE, EMBASE, The Cochrane Library, Cochrane Occupational Health Field's specialised register, DARE, PsychINFO, ERIC, ETOH, CISDOC, NIOSHTIC, TRANSPORT, Zetoc, Science Citation Index and Social Science Citation index and HSELINE. We also searched reference lists, relevant websites and conducted hand searching.

Selection criteria

Randomised controlled trials (RCTs), cluster-randomised trials, controlled clinical trials, controlled before and after studies (more than three time points to be measured before and after the study) and interrupted time-series (ITS) studies that evaluated alcohol or drug screening interventions for occupational drivers (compared to another intervention or no intervention) with an outcome measured as a reduction in injury or a proxy measure thereof.

Data collection and analysis

Two review authors independently extracted data and assessed study quality. We contacted authors of the included studies for further information.

Main results

We included two interrupted time-series studies conducted in the USA. One study was conducted in five large US transportation companies (N = 115,019) that carried passengers and/or cargo. Monthly injury rates were available from 1983 to 1999. In the study company, two interventions of interest were evaluated: mandatory random drug testing and mandatory random and for-cause alcohol testing programmes. The third study focused only on mandatory random drug testing and was conducted on federal injury data that covered all truck drivers of interstate carriers.

We recalculated the results from raw data provided by the study authors. Following reanalysis, we found that in one study mandatory random and for-cause alcohol testing was associated with a significant decrease in the level of injuries immediately following the intervention (-1.25 injuries/100 person years, 95% CI -2.29 to -0.21) but did not significantly affect the existing long-term downward trend (-0.28 injuries/100 person years/year, 95% CI -0.78 to 0.21).

Mandatory random drug testing was significantly associated with an immediate change in injury level following the intervention (1.26 injuries/100 person years, 95% CI 0.36 to 2.16) in one study, and in the second study there was no significant effect (-1.36/injuries/100 person years, 95% CI -1.69 to 0.41). In the long term, random drug testing was associated with a significant increase in the downward trend (-0.19 injuries/100 person years/year, 95% CI -0.30 to -0.07) in one study, the other study was also associated with a significant improvement in the long-term downward trend (-0.83 fatal accidents/100 million vehicle miles/year, 95% CI -1.08 to -0.58).

Authors' conclusions

There is insufficient evidence to advise for or against the use of drug and alcohol testing of occupational drivers for preventing injuries as a sole, effective, long-term solution in the context of workplace culture, peer interaction and other local factors. Cluster-randomised trials are needed to better address the effects of interventions for injury prevention in this occupational setting.

摘要

背景

預防執業駕駛受傷所執行之酒精和藥物篩檢

勞工酒精和藥物驗測是常見的事,但是否能有效降低職業傷害仍然不明確。

目標

本文旨在評估職業駕駛(或馬達工具操作者)的酒精和藥物篩檢對於預防受傷或與工作相關之影響,如因受傷導致生病缺席。

搜尋策略

我們搜尋以下的資料庫,更新到2007年(或者更新到最近一次可用的發佈):MEDLINE, EMBASE, The Cochrane Library, Cochrane Occupational Health Field's specialised register, DARE, PsychINFO, ERIC, ETOH, CISDOC, NIOSHTIC, TRANSPORT, Zetoc, Science Citation Index and Social Science Citation index and HSELINE。我們也搜尋參考文獻表、相關的網站、及執行手動搜尋。

選擇標準

只要是評估職業駕駛接受酒精或藥物篩檢(與接受其他介入方式或沒有執行任何介入比較)並報告傷害降低程度或其他相關測量指標結果之隨機對照試驗(Randomised controlled trials)、隨機群組研究(clusterrandomised trials)、控制臨床試驗(controlled clinical trials)、前後對照試驗(controlled before and after studies)(試驗前後各有3次以上測量點)及間斷時間序列試驗(interrupted timeseries (ITS)studies)都會被收錄。

資料收集與分析

本研究中由兩位作者獨立的摘取資料及評估研究品質。此外,我們也與納入之研究作者聯繫以獲得更多的資訊。

主要結論

我們納入了兩篇在美國進行的間斷時間序列的研究(interrupted timeseries studies)。一篇研究是在美國五大專門運載乘客及/或貨物的運輸公司進行的(N = 115019)且有紀錄1983 – 1999年每月的傷害率。在這些研究的公司中,他們評估兩種介入措施:強制的隨機藥品檢測和強制的隨機及尋因酒精檢測計畫(forcause alcohol testing programmes)。第三個研究只集中於強制隨機藥品檢測,資料建立於包括全部州際間搬運卡車司機的聯邦政府傷害資料上,我們從研究作者提供的原始資料重新計算結果。再分析後,有一篇研究結果顯示強制的隨機及尋因的酒精檢測可以顯著的降低傷害程度(−1.25 injuries/100 person years, 95% CI −2.29 to −0.21),但無法顯著的影響現存長期下降的傾向(−0.28 injuries/100 person years/year, 95% CI −0.78 to 0.21)。在一個研究中顯示強制隨機藥物檢測介入後可顯著的的立即改變傷害程度(1.26 injuries/100 person years, 95% CI 0.36 to 2.16),但在第二個研究中則沒有顯著的效果(−1.36/injuries/100 person years, 95% CI −1.69 to 0.41)。就長期而言,其中一個研究顯示隨機藥物檢測可顯著的增加其傷害降低趨勢(−0.19 injuries/100 person years/year, 95% CI −0.30 to −0.07),而另一個研究中也顯示可顯著的改善長期的死亡下降趨勢(−0.83 死亡事故/100 百萬運載哩數/年,95% CI −1.08 to −0.58)。

作者結論

沒有足夠的證據建議或反對使用職業駕駛的藥物和酒精檢測,來做為在工作文化、同儕相互影響、及其他當地的因素的脈絡中,預防傷害的專門、有效、長期的解決方案。需要群集隨機的試驗,較能提出在職業場域中為了預防傷害的介入措施的效果。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

酒精及藥物濫用是遍及世界的嚴重的公共健康問題。工作場所中酒精和藥物檢測是一個常見的介入措施,特別在發展中的國家,但是它是高成本的,並且它的使用是有爭議的。這篇系統性的查證要旨在於評估酒精和藥物篩檢,在職業駕駛中預防傷害的效果。我們進行系統性的搜尋探討酒精和藥物篩檢對於預防職業駕駛傷害之效果的相關文獻。我們評讀所搜尋到的文獻品質並評估其結果。我們發現兩篇在美國進行的時間序列的研究。一篇在五大運輸公司進行的,它檢查兩個所關心的介入措施的效果:執行強制隨機藥物檢測及強制隨機酒精檢測的立法。另一個研究利用全國性的傷害資料進行探討。並沒有足夠的證據顯示,長期的強制藥物檢測介入措施比起沒有介入,可以有效的降低職業駕駛的傷害。強制酒精檢測僅證實有立即的效果。由於已普遍實施酒精和藥物檢測但仍缺乏相關的評估研究,因此未來仍然需要更多的研究。間斷的時間序列是一個可行的研究設計。無論如何,高品質及長期的時間序列研究是需要的,且可增加證據等級。群集的隨機試驗也將是評估在職場中預防傷害的介入效果的理想研究設計。

Plain language summary

Alcohol and drug screening for preventing injury among people whose job involves driving

Alcohol and drug abuse are serious public health problems worldwide. Workplace alcohol and drug testing is a common intervention, especially in developed nations, but it is costly and its use is controversial. This systematic review aimed to assess the effects of alcohol and drug screening among occupational drivers for preventing injury.

We conducted a systematic search of the literature on the effects of alcohol and drug screening among occupational drivers for preventing injury. We then appraised the quality of the studies found and assessed their results. We found two time-series studies conducted in the USA. One was conducted in five large transportation companies, and it examined the effects of two interventions of interest: implementation of legislation for mandatory random drug testing and mandatory random and for-cause alcohol testing. The other study was conducted using national injury data.

There is limited evidence that in the long term mandatory drug-testing interventions can be more effective than no intervention in reducing injuries in occupational drivers. For mandatory alcohol testing there was evidence of an immediate effect only.

Given the widespread practice of alcohol and drug testing and the paucity of evaluation studies found, more evaluation studies are needed. Interrupted time-series is a feasible study design for evaluating interventions that aim at preventing alcohol and drug related injuries. However, time-series studies of higher quality and of long duration are needed to increase the level of evidence. A cluster-randomised trial would be the ideal study design to evaluate the effects of interventions for injury prevention in this occupational setting.

Get access to the full text of this article

Ancillary