Impact of Personal Protective Equipment in Preventing Occupational Injuries: A Systematic Review and Meta-analysis

Weiner Santos¹Alejandro Lorente^2*Gonzalo Mariscal^1*Gonzalo Mariscal^3*Rafael Lorente⁴

• ¹Universidad de Extremadura, Badajoz, Spain
• ²Hospital Universitario Ramon y Cajal, Madrid, Spain
• ³Catholic University of Valencia San Vicente Mártir, Valencia, Spain
• ⁴Universidad de Extremadura - Campus Badajoz, Badajoz, Spain

Background: Occupational injuries remain a significant public health concern across diverse industries, with personal protective equipment (PPE) widely advocated to mitigate risk. However, the real-world effectiveness of PPE and factors influencing its use require synthesis. Our objective is to determine whether the use of personal protective equipment (PPE) reduces the occurrence of occupational injuries among workers in high-risk industries. Methods: A comprehensive search was done to include all relevant studies published between January 2000 and June 2025 in PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase, following the PRISMA 2020 recommendations. Studies that met the criteria included adult workers in construction, mining, manufacturing, agriculture, or related fields. They examined PPE interventions (helmets, gloves, goggles, respirators, safety shoes, high-visibility apparel, and harnesses) and reported on injuries and compliance measures. Two reviewers independently screened studies, extracted data, and assessed quality using the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed in R to pool injury prevalence, PPE effectiveness (ORs), and compliance rates; heterogeneity was quantified via I², and publication bias via funnel plots and Egger’s test. Results: Eighteen cross-sectional studies (n=7,612 workers) were included. A meta-analysis of 15 studies (N = 6,325) found that only about half of workers used personal protective equipment (PPE) (pooled prevalence = 51%, 95% CI 39–62%) with extreme heterogeneity. Industry type, rather than age or gender, explained the most variability, with use being higher in industries such as heavy industry, metalwork, and manufacturing. The main barrier was a lack of PPE (72%), followed by discomfort, poor training, and time-saving motives. Compliance was highest for basic equipment and lowest for specialized equipment. Supervision and safety training significantly reduced the risk of injury (OR = 2.04 and 1.81, respectively). Conclusion: PPE use is associated with lower odds of occupational injury, and the prevalence of occupational injuries is higher when PPE is available, properly fitted, and supported by training and supervision. However, low compliance was driven primarily by supply and ergonomic factors. Integrated strategies encompassing reliable PPE provisioning, user-centered design, comprehensive training, and organizational commitment are essential to enhance workplace safety.