The European Union (EU), in 1992, issued the Temporary or Mobile Construction Sites (TMCS) Directive, which requires EU members to introduce specific law to improve health and safety (H&S) performance outcomes by placing specific duties on key stakeholders. This Directive led to the introduction of the first Construction (Design and Management) (CDM) Regulations in the UK construction industry on 31 March 1995 and since their introduction, the overall performance of construction H&S has improved gradually. However, despite this positive outlook, there are still significant concerns surrounding the implementation of the CDM Regulations, a subject on which empirical research has been very scanty. It is against such a background that this study investigates the practical implementation of the CDM Regulations and extends current knowledge and understanding, and develops a framework for appropriate remedial action by industry. The research method involved a thorough critical review of literature, semi-structured interviews, and two postal questionnaire surveys, using as research informants, practitioners with experience of the Designer, CDM Coordinator (CDM-C), and Principal Contractor (PC) roles under the CDM Regulations. Primary data were collected and analysed from in-depth interviews with six organisations purposively selected based on their construction design expertise and 122 questionnaires returned in total. The finding regarding lack of collaborative working amongst duty holders is a significant outcome of this study; a requirement expressed explicitly within the CDM Regulations, yet questionable in terms of its implementation. Further, the study reveals a number of statistically significant correlations between the extent of discharge of duties and their perceived degree of importance. However, the strength of the majority of these correlations is weak. In particular, the evidence indicates that 50% of the duties of the CDM-C are misaligned in terms of extent of discharge and perceived degree of importance, whereas 25% of the PC duties are also misaligned. This signals a lack of understanding regarding the importance of duties, towards achieving improved H&S management. Surprisingly, a comparison between extent of discharge of duties and their perceived degree of difficulty reveals that all the duties of the PC are statistically significant, meaning that the perceived degree of difficulty does not impede their extent of discharge. While 90% of the CDM-C duties are also statistically significant, again the same interpretation applies. Further, a consensus reached by Designers supports the view that CDM-Cs provide insufficient input throughout the planning and construction phase, raising doubt as to whether the duty holder is fit for purpose. Overall, the results confirm that interdependent working of duty holders is still a challenge, demonstrated by the Designer duty to ensure appointment of the CDM-C (Regulation 18(1)), the CDM-C duty to ensure Designers comply with their duties (Regulation 20(2)(c)), and the PC duty to liaise with the CDM-C and Designer (Regulation 22(1)(b)). Three recurring themes emerge from the results, that is: (i) collaboration, (ii) accountability and compliance, and (iii) facilitation, which in turn inform the remedial action framework comprising 13 remedial actions and 8 change drivers. Validation of the remedial action framework by 15 study participants reveals that, at least 10 remedial actions and 7 change drivers are considered likely to improve CDM implementation. The top three remedial actions are: (i) ensuring adequate arrangements for coordination of H&S measures; (ii) including provisions within the regulations specifying the stages for the appointment of duty holders; and (iii) amending the ACoP to provide guidance on determining what resources are adequate for a particular project. Whereas, the top three change drivers are: (i) management leadership; (ii) the proactive participation of duty holders; and (iii) training to equip duty holders with sufficient knowledge on provision of timely and adequate preconstruction information. Based on these outcomes, conclusions, recommendations, and further areas of research are drawn.

Magister Curationis - MCur / Background: Health care workers who sustain needle stick injuries are at risk of contracting blood-borne pathogens, e.g. Human Immunodeficiency Virus,Hepatitis B virus or Hepatitis C virus. Needle stick injuries are viewed as occupational hazards that can lead to health care workers developing acute or chronic diseases, which may lead to disability or death. Due to these healthrelated risks, health care workers are encouraged to adhere to universal precautions and standard operating procedures. In South Africa, the Occupational Health and Safety Act promulgated in 1993 required institutions draw up protocols in line with the regulations of the Act. However, if the health care workers do not comply with the protocols they may not be compensated for contracting a disease, e.g. Human Immunodeficiency Virus infection, following needle stick injuries. Aim: The aim of the study was to explore the health care workers’ perceptions of the needle stick injury protocol at a level 2 hospital in Cape Town. Research design: A qualitative approach was used to make sense of health care workers’ compliance to the protocols when sustaining a needle stick injury. An exploratory descriptive, contextual design was used to carry out an in-depth investigation of the phenomenon. Sample: The study was done at Mowbray Maternity Hospital, a level 2 obstetric hospital in Cape Town. The researcher made use of convenience, purposive sampling. Semi-structured interviews were used to collect the research data. Data collection: During the data collection phase, ethical considerations towards participants were ensured to include, among others, anonymity, autonomy and confidentiality of information. Data analysis: It included the following steps: reading and rereading,coding, displaying, reducing and interpreting the data. Findings: Some health care workers do not view sustaining a needle stick injury as risky enough to report the injury or even go for follow-up testing. This risky behaviour can have detrimental effects on their health. There is also a lack of knowledge about the institutional needle stick injury protocol. Recommendations: It is recommended to have educational and training sessions for all health care workers and new employees to familiarise them with the needle stick injury protocol and policies of the institution; to provide adequate management support 7 following work related injuries and to make health care workers aware of the consequences of non-compliance to institutional protocol.