title: Interventions to prevent injuries in construction workers.
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.
  
  
  OBJECTIVE
  To assess the effects of interventions to prevent injuries in construction workers.
  
  
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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).
  
  
  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.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, Netherlands.h.f.vandermolen@amc.nl.
authors.forename: Henk F
authors.initials: HF
authors.lastname: van der Molen
authors.forename: Marika M
authors.initials: MM
authors.lastname: Lehtola
authors.forename: Jorma
authors.initials: J
authors.lastname: Lappalainen
authors.forename: Peter L T
authors.initials: PL
authors.lastname: Hoonakker
authors.forename: Hongwei
authors.initials: H
authors.lastname: Hsiao
authors.forename: Roger
authors.initials: R
authors.lastname: Haslam
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hale
authors.forename: Monique H W
authors.initials: MH
authors.lastname: Frings-Dresen
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D000062:Accidents, Occupational / Q000331:legislation & jurisprudence / Q000401:mortality / Q000517:prevention & control*; D060389:Construction Industry / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D016272:Occupational Health / Q000331:legislation & jurisprudence; D060051:Occupational Injuries / Q000401:mortality / Q000517:prevention & control*