OBJECTIVES: Small enterprises have higher exposure to occupational hazards compared to larger enterprises and further, they have fewer resources to control the risks. In order to improve the working environment, development of efficient measures is therefore a major challenge for regulators and other stakeholders. The aim of this paper is to develop a systematic model for the design of tailored intervention programmes meeting the needs of small enterprises. METHODS: An important challenge for the design process is the transfer of knowledge from one context to another. The concept of realist analysis can provide insight into mechanisms by which intervention knowledge can be transferred from one context to another. We use this theoretical approach to develop a design model. RESULTS: The model consist of five steps: 1) Defining occupational health and safety challenges of the target group, 2) selecting methods to improve the working environment, 3) developing theories about mechanisms which motivate the target group, 4) analysing the specific context of the target group for small enterprise programmes including owner-management role, social relations, and the perception of the working environment, and 5) designing the intervention based on the preceding steps. We demonstrate how the design model can be applied in practice by the development of an intervention programme for small enterprises in the construction industry. CONCLUSION: The model provides a useful tool for a systematic design process. The model makes it transparent for both researchers and practitioners as to how existing knowledge can be used in the design of new intervention programmes.
Construction Industry ; Occupational Health

Problem: One month after the initial case of coronavirus disease 2019 (COVID-19) in Tasmania, an island state of Australia, two health-care workers (HCWs) from a single regional hospital were notified to public health authorities following positive tests for SARS-CoV-2 nucleic acid. These were the first recognized cases in an outbreak that overwhelmed the hospital’s ability to function. Context: The outbreak originated from two index cases. Both had returned to Tasmania following travel on a cruise ship and required hospital admission for management of COVID-19. A total of 138 cases were subsequently linked to this outbreak: 81 HCWs (most being nurses) and 23 patients across three hospitals, one resident of an aged-care facility and 33 close contacts. Action: The outbreak was controlled through the identification and isolation of cases, identification and quarantining of close contacts and their household members, closure of the affected facilities and community-level restrictions to reduce social mixing in the affected region. Lessons learnt: Factors that were likely to have contributed to ongoing transmission in this setting included workplace practices that prevented adequate physical distancing, attending work while symptomatic, challenges in rapidly identifying contacts, mobility of staff and patients between facilities, and challenges in the implementation of infection control practices. Discussion Many commonly accepted hospital practices before the COVID-19 pandemic amplified the outbreak. The lessons learnt from this investigation changed work practices for HCWs and led to wider public health interventions in the management of potential primary and secondary contacts.