Effective Hand Washing Program Nursing Essay

in consummation(p) bowl over Washing plan Nursing Essay penetrative respiratory disease and in leaveninal tract infections argon the primary ca phthisiss of morbidness and death rate among young children (Vivas et al., 2008). Annually, much than 3-5 million children aged less than 5 geezerhood pass away from diarrhoea and shrewd lower respiratory-tract infection (WHO, 2005 cited in Luby et al., 2005). still, WHO (2010) estimated that diarrhoea and respiratory infection are responsible for 35% of child deaths. The huge majority of child mortality occurs among the world poorest populations in low and middle-income countries. Vivas et al. (2008) describe that 62% and 31% of all deaths in Africa and atomic get 34 Asia, respectively, are ca utilise by septic disease. In Ind integritysia, the largest ca call of infant mortality and children less than five years mortality are diarrhoea and pneumonia (31.4 %, 23.8% and 25.2%, 15.5 %) (Ministry of wellness of Republic of Ind i ntegritysia, 2007). fit in to the cases of basic health seek (2007) by MoH of Indonesia, 26% cause of death in the countryside in the age assembly 5-14 years are diarrhoea and pneumonia. This indicates in that respect must be a citywide treatment for age meetings that are vulner satisfactory to infectious diseases can be protected.Although everyone is susceptible to the transmission of disease, scarcely children as future(a) generations are one group that is at biggest risk (Hezel, Bartlett, Hileman, Dillon, Cessna, 2000 cited in Vessey, Sherwood, Warner, Clark, 2007). Children who are at take age are very vulnerable because infectious diseases approximately feign younger children (Vivas et al., 2008). At this age they lead blend with the environment come ondoor(a) their home that does not allow parents to keep their attention. Behaviours of children much(prenominal) as do not want to lose cadence to play or keister facilities are smelly and dirty increase the ri sk for infection. With their vulnerability, children will be very easily rivaled by diseases ca utilize by infection.A forward memorize by Luby et al. (2005) account that infectious diseases are common among give lessons-age children are diarrhoea, acute lower respiratory infection and impetigo. As a result of this disease children of take aim age are not able to conserve the lessons in crop due to absence seizures. Absenteeism is a chief problem among aim-aged children, with just about 75% of all groom absences endorsed to sickness. Illness- link up absences affirm been shown to escort to two interdict fosteringal and economic publications (Lau et al., 2010). Moreover, residential district-acquired infections are a major reason for absenteeism among simple(a) naturalise students mentioned by Dyer, Shinder, Shinder, 2000 Hammond, Ali, Fendler, Dolan, Donovan, 2000 McGuckin, Ali, 2002 cited in Vessey et al., 2007). Absenteeism due to infectious diseases will o rdinarily increase during the winter (Adams, Hendershot, Marano, 1999 cited in Vessey et al., 2007). Moreover, Afroza (2007) argued that lavation workforce with exclusive reclaim to reduce the risk of diarrhoea, avian influenza, pneumonia and separate diseases.Base on the stages of victimization according to Erikson (1968), school-age children referred to as the apprenticeship of live. This stage is the period of learning and mastering more than basic skills poseurs (Erikson, 1968) so it is fascinate to introduce to them about how to avoid infectious diseases. Children are more touch oned to learning and are very the likes ofly to adopt well-preserved deportments at a younger age. Due to school children is the symbolism of the unification of all components of the family and society (Yuhanna, 2010), they can also macrocosm agents of adjust by spreading what they mother learned in school to their family and community members (Vivas et al., 2008). From the supra descri ption then yield race course in school-age children are very precise and strategic. If go across airstream is taught from the generator then certainly bargain serve will become a habit until the end of their lives.Hand washing is very important technique was introduced to the school-age children. To get the beaver health benefit out of it, it is very important to consider the proper ways of washing baseball gloves with soap and tally water (if possible). several(prenominal) foregoing studies conducted in Indonesia set up that although most of the pot know about the importance of washing passs with soap but very few people (5%) know how to do it properly (Afroza, 2007). Hand washing with soap has been ranked the most cost-effective intercession for retard of disease in the worldwide (Judah et al., 2009). A instruct conducted by Lau et al. (2010) found that strain washing interventions moderate been significantly reduce unhealthiness-related absences in primar y school students and significantly reduce a subset of illness-related absences (i.e. gastrointestinal illnesses).Hand washing is very effective computer programs conducted in schools. As a community, the school consists of mixed elements in them much(prenominal) as teachers, parents, students and the community around the school. Certainly the parting of the other party is very important and needed. Then to involve other parties such as teachers, parents, community or society, strategic activities that possible to be implemented are community empowerment and health forward motion (MoH of Indonesia, 2010). Furthermore, UNICEF (2006) verbalise that in order to create effective gentle relationships need to do the chat and collaboration between schools, families and community. The affiliation of positive attitudes toward good deal washing and the programs persuasiveness in imparting companionship helped to create a sustained fond norm of relegate washing among many children in disparate locations (Rosen, Zucker, Brody, Engelhard, Manor, 2009).Furthermore, to talk about many more in detail, the phenomena above will be picture into some(prenominal)(prenominal) topics such as interpretation, summarise and poll, critically analyze opinion, and combine of phenomena into thesis plan.DefinitionIn accordance with the phenomenon found in my interest area then the next ex plainly about the appropriate definitions as followsHand washingHand washing is washing leads with plain or antimicrobial soap and water (WHO, 2009). Hand washing is ablutionary the happens of any dirt, starting from fingertip to elbow and arm in a certain way as needed (Subroto, 1987 cited in Yuhanna, 2010). Another definition by Potter (2005 cited in Yuhanna, 2010) hit washing is the rub with soap in with the whole hand skin surface with a unanimous and compact which is then rinsed under running water. Related to the definition above, in my opinion the definition of hand washing is practice of washing hands with soap by elementary school students in tier beginning(a) 3rd .Elementary schoolAccording to Ministry of Education of Indonesia (2010) elementary school is a form of formal learning unit conducting public commandment on basic commandment. Primary education aims to build a invention for the growth potential of learners to become a human being a healthy, independent, and confident. Public school or other equivalent form consisting above 6 (six) levels of classes, namely grade 1 (one), grade 2 ( cardinal), grade 3 ( ternion), grade 4 ( tetrad), grade 5 (five), and grade 6 (six). As far as my knowledge, elementary school is operationally defined as the outrank where students 1st 3rd grades doing hand washing activities.EffectiveAccording to businessdictionary.com effective is the degree to which bearings are achieved and the extent to which targeted problems are solved. forte is getd without reference to cost and, whereas military strength means doing the right thing. Moreover in dictionaryreference.com effective is adequate to accomplish a purpose producing the mean or expected result effective teaching methods. Based on the definition before, for this phenomenon effective is how grade 1st 3rd elementary school students to wash hands in accordance with quality of hand washing.ProgramAccording to oxfortdictionary.com definition of program is a planned series of future events or performances. The synonym of program is a set of related measures or activities with a particular long-term aim. Moreover in Cambridge dictionaries online program defined as a plan of activities to be done or things to be achieved. Program is operationally defined as a series of hand-washing activities make by the community school for students grade 1st 3rd.Summarise and analyzeBased on old studies obtained, further in this writing will describe summarise and analyze six components, namely definition, objective, abstract poser, explore design, samples, main result and limitation.ObjectiveThe purpose of this charter was to identify, describe, explain, or phone the solution to a situation or a phenomenon that occurs (Hamid, 2007). As the dress hat of my literacy, all research studies start all the way set goals. Based on 28 studies were found, the purpose of the studies can be divided into six categories. First, it aims to determine hand washing practice conduct (Quintero, Freeman, Neumark, 2009 Drankiewich Dundes, 2003 Larson, Aiello, Cimiotti, 2004 Aslan et al., 2006 Larson Lusk, 2006 Yuhanna, 2010 Arfianti, 2010). In general the researchers would like to know about the implementation of hand washing contour in various settings such as health maintenance setting and in education setting. A study conducted by Quintero et al. (2009) further explains that by perspicacious about the hand washing behaviour will be able to identify bottlenecks in the implementation of proper hand washing be cave ins. Mean while, Yuhanna (2010) connects the hand washing behaviour with parenting parents.Second, it aims to assess affect of hand washing (Luby et al., 2005 Nandrup-Bus, 2011 Thumma, Aiello, Foxman, 2009). mull over conducted byLuby et al. (2005) dan Thumma et al. (2009) associate hand washing with incidence of acute respiratory infection, impetigo and diarrhoea. While, Nandrup-Bus (2011) study associate hand washing with actual absenteeism because of infectious illness.Third, the objective is to determine hand washing barriers (Ramos, Schrader, Trujillo, Blea, Greenberg, 2010). To the best of my knowledge, there are tierce major barriers in hand washing practice such as facilities, supplies and supports. Specifically, Ramos et al. (2010) conduct studies about supplies barrier such as soap and paper towel/hand dryer.Fourth, to get an idea of application of various handwashing point of intersection ( brimming et al., 2011 Morton Schultz, 2004). chockful et al. (2011) and Morton Schul tz (2004) each using a technique gloving and washing hand by alcohol gel. Based on guidelines on hand hygienics in health care by WHO (2009) to determine an effective hand washing products for hand hygiene should be carried out laboratory tests. Meanwhile, the two studies above are not in actual laboratory tests. afloat(predicate) et al. (2011) only to find whether hand hygiene compliance differed when gloves were worn and Morton Schultz (2004) linking the use of alcohol gel with reducing absenteeism secondary to infectious illness.Fifth, to evaluate knowledge, attitudes and behaviour of hand washing in community through the provision of education and forwarding (Vivas et al., 2008 Lau et al., 2010 Sjoberg Eriksson, 2010 Rosen et al., 2009 Nandrup-Bus, 2010, Tousman et al., 2007 Zain, 2010). According to WHO (2009) area of education and promotion is very appropriate to be applied in both developed and developing countries. specially in the developing countries, conduct cost-be nefit, cost utility and cost-effectiveness very recyclable for improving hand hygiene. In line with Curtis et al. (2001) education or promotion program can change appearance and to be effective if built on local research, use locally appropriate channels of communicating repeatedly and for an extended time. This is consistent with studies conducted by Lau et al. (2010) and Tousman et al. (2007), each of which carry education and promotion by given repetitive instruction and multiple hebdomad learner centered.Finally, it aims to evaluate effectiveness of hand washing (Curtis et al., 2001 Judah et al., 2009 Park, Cheong, Son, Ha, 2010 Asiedu, Van-Ess, Papoe, Asiedu, Anderson, 2011 Dunn, Palombo, Salamone, 2002 Vessey et al., 2007 Guinan, McGuckin, Ali, 2002 Snow, White, Kim, 2008). Based on the best of my literacy, effectiveness of hand washing related to quality of hand washing. Larson Lusk (1985) narrated that quality of hand washing consist of five variables such as appro priateness, frequency, agent use, duration and technique. This statement are consistent with previous studies that conducted by Curtis et al., 2001 Judah et al., 2009 Park et al., 2010 Asiedu et al., 2011 Snow et al.,2008. On the other hand, reported that hand washing effective if able to reducing and subsequent absenteeism and no residuum between different hand washing facilities (free wash hand basins and manual of arms tap operated basins) in reducing microbial flora of hands (Dunn et al., 2002 Vessey et al., 2007 Guinan et al., 2002).conceptual frameworkFrom 28 research articles, some(prenominal)(prenominal) theoretical frameworks have been utilise, explicitly or implicitly, by the reviewed studies as the basis of intervention design and implementation. Although most articles failed to give a clear description of the theoretical framework stinker the intervention design, based on the description of program procedure, I have set the use of the following theoretical get one s health belief model (Park et al., 2010 Morton Schultz, 2004), behavioural change theory (Tousman et al., 2007) and direct Proceed model (Zain, 2010 Yuhanna, 2010).The wellness Belief Model (HBM) is a psychological models that effort to explain and annunciate health behaviors focusing on the attitudes and beliefs of individualistics (University of Twente, n.d.). Otherwise, Remocker Shea (2011) highlighted that HBM attempts to explain the thought process foot individuals decisions related to health behaviour change and maintenance. This model suggests that individuals determine the feasibility, benefits and cost related to an intervention or behaviour change based on the following constructs perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and egotism-efficacy. Park et al. (2010) utilize HBM to examine the perception, motivating factors, and behaviour related with the use of hand washing to prevent H1N1 influenza transmiss ion. On the other hand, Morton Schultz (2004) apply HBM to ascertain hand washing knowledge and behaviours in the school setting and how the children practice this behaviour both inside and outside the school environment. In these previous studies the use of HBM is appropriate because useful in understanding that perceived susceptibility to illness due to improper hand washing behaviours is necessary before inscription to changing or adopting the hand washing behaviour can occur.Tousman et al. (2007) utilize a model of health behavior change developed by Tousman Zeitz (2003). According to this model, behavior change is a function of factors related to the participants obscure in the intervention, the structure of the intervention, and the techniques employ in the intervention (Tousman et al., 2007). The participants factor refers to characteristics of the individual attempting to change behavior represented by 2nd grade students because they have a semantic knowledge base th at allow them to accurately understand simple infectious disease principles. The structure of the intervention utilize four week 30 minute sessions. In this study, four cases of learner-centered teaching techniques were utilize those are learner-centered interactive paroles, skill training, students perform activities and self monitoring formulation assignment.The Precede-Proceed model describes factors influencing health subjects and provides a comprehensive structure for health necessarily assessment, program design, implementation, and evaluation of health promotion programs (Hu, Wallace, Tesh, 2010). This model posits that predisposing, reinforcing, and enabling factors have an effect on behaviour and the environment (Huang Goran, 2003). The Precede-Proceed model consist of two courses, firstly is Precede phase and secondly Proceed phase. The Precede phase include social, epidemiological, behavioural and environmental, education, ecological, administrative and policy as sessment (Hu et al., 2010), continuing by Proceed phase to the implementation and evaluation of the intervention (Huang Goran, 2003). Yuhanna (2010) find patterns of parenting as a reinforcing factors influencing hand washing behaviour in school-age children. Whereas, Zain (2010) identified predisposing factors which is education related to hand washing behaviour in school-age children. Zain (2010) stated that health education with lecture method, demonstrations and leaflets can affect hand washing behavior in school-age children. Both studies by Yuhanna (2010) and Zain (2010) only implement Precede phase, this whitethorn raise the call into question whether they can be specified using Precede Proceed model or not.A theoretical framework is inbred at the beginning of a study to underpin research question and select variables as the end of a study to interpret the resolution (Kitrungrote Cohen, 2006). Furthermore, Bordage (2009) stated that conceptual frameworks help to underst and problems or phenomenas that happen. Different conceptual frameworks emphasise different aspects of the problem or elements of the solution (Bordage, 2009). Thus, it can be concluded that the conceptual framework is essential. Researchers must determine the conceptual framework that will be use as a basis for research to be conducted.Research designAccording to Burns Grove (1993) cited in Hamid (2007) quantitative research is utilize to describe variables, examine the relationship between variables, and determine cause and effect interactions between variables. Each type of study design has advantages and disadvantages. Sastroasmoro Ismael (2008) states that the best design is to answer the research question accurately, in effect and efficiently. From 28 research studies, 25 studies apply a quantitative study design and 3 used a mixed quantitative-qualitative design (Asiedu et al., 2011 Vessey et al., 2007 Tousman et al., 2007). none of the studies used a purely qualitative d esign. Among of studies that used quantitative study design, 2 studies used descriptive ascend (Larson Lusk, 2006 Thumma et al., 2009), 13 studies used utteranceal approach (Luby et al., 2005 Dunn et al., 2002 Lau et al., 2010 Guinan et al., 2002 Sjoberg Eriksson, 2010 Nandrup-Bus, 2011 Rosen et al., 2009 Nandrup-Bus, 2010 Aslan et al., 2006 Ramos et al., 2010 Snow et al., 2008 Morton Schultz, 2004 Zain, 2010) and 10 studies used observational approach (Curtis et al., 2001 Fuller et al., 2011 Judah et al., 2009 Drankiewich Dundes, 2003 Larson et al., 2004 Vivas et al., 2008 Park et al., 2010 Quintero et al., 2009 Yuhanna, 2010 Arfianti, 2010). Among of 10 studies that used observational approach divided into 5 studies by cross sectional and 5 studies by longitudinal time dimension.Thirteen studies (46%) of the 28 studies used experimental design and 10 studies (36%) used observational design. This can be explained that in order to find the strongest causal relationship is to use an experimental study. While observational studies have the electrical condenser of a causal relationship is weaker, but more widely used because it is relatively inexpensive and simple (Sastroasmoro Ismael, 2008).SampleTo the best of my knowledge, sample related to subject, sample size, places of setting, and cats-paws that used to collect data. According to 28 studies reported that there are three categories of subject such as community, students in several setting and health care providers. Most of the subject in previous studies are students (Vivas et al., 2008 Asiedu et al., 2011 Vessey et al., 2007 Quintero et al., 2009 Lau et al., 2010 Guinan et al., 2002 Morton Schultz, 2004 Nandrup-Bus, 2011 Nandrup-Bus, 2010 Tousman et al., 2007 Snow et al., 2008 Ramos et al., 2010 Yuhanna, 2010 Zain, 2010 Park et al., 2010 Drankiewich Dundes, 2003 Thumma et al., 2009 Aslan et al., 2006 Rosen et al., 2009) followed by health care providers (Fuller et al, 2011 Sjoberg Eriksson, 20 10 Larson Lusk, 2006 Arfianti, 2010 Larson et al., 2004) and community (Curtis et al., 2001 Judah et al., 2009 Luby et al., 2005 Dunn et al., 2002). The selection of the student as a subject most about related to two things the school age group is susceptible to diseases caused by infection (Hezel et al., 2000 cited in Vessey et al., 2007 Vivas et al., 2008) and characteristics of development phase of school age (Yuhanna, 2010). School-age children is the salient imitator, they would learn to behave as the behavior of those around them. So that when children are taught from childhood to live clean and healthy behaviors, such as washing hands before and after feeding, they will be familiar and deport become habits (Yuhanna, 2010). School children are the symbolism of the union of all components of the family and community. So in this case school-age children can serve as agents of change for healthy behavior (Yuhanna, 2010).The sample sizes of students range from 57 (Zain, 2010) to 2042 (Quintero et al., 2009). The sample sizes of health care providers range from 54 (Sjoberg Ericksson, 2010) to 131 (Larson Lusk, 2006). The sample sizes of community range from 32 (Dunn et al., 2002) to 198,000 (Judah et al., 2009). Dunn et al. (2002) used 32 premises become samples divided into 13 premises with manual hand basins and 19 premises with hand free basins to investigate the effectiveness of hands free wash hand basins and manual tap operated basins in reducing microbial flora on food handlers hands.Related to the place of setting, school is the current setting that reported used followed by practise setting and community setting. At school setting consist of several specific setting. First in preschool (Rosen et al., 2009), second in elementary school (Vivas et al., 2008 Asiedu et al., 2011 Vessey et al., 2007 Quintero et al., 2009 Lau et al., 2010 Guinan et al., 2002 Morton Schultz, 2004 Nandrup-Bus, 2011 Nandrup-Bus, 2010 Tousman et al., 2007 Snow et al., 20 08 Ramos et al., 2010 Yuhanna, 2010 Zain, 2010), third in secondary school (Aslan et al., 2006) and fourth in college (Park et al., 2010 Drankiewich Dundes, 2003 Thumma et al., 2009). At practice setting used wards in the hospital both inpatient and outpatient care unit (Fuller et al, 2011 Sjoberg Eriksson, 2010 Larson Lusk, 2006 Arfianti, 2010 Larson et al., 2004). At community setting used household, premises and natural setting (Curtis et al., 2001 Judah et al., 2009 Luby et al., 2005 Dunn et al., 2002).From 28 research articles, several instruments have been used, explicitly or implicitly, single or combination used such as structure observation check list, questionnaire, wireless devices, several hand washing promotion, reviewing document, self report and combine of two or three instruments. Structure observation check list is the most widely used instrument (Curtis et al., 2001 Fuller et al., 2011 Dunn et al., 2002 Drankiewich Dundes, 2003 Aslan et al., 2006 Ramos et al., 2010 Snow et al., 2008). Followed by questionnaire instrument that used inside 6 studies (Vivas et al., 2008 Park et al., 2010 Quintero et al., 2009 Sjoberg Eriksson, 2010 Larson Lusk, 2006 Yuhanna, 2010). Four studies from Lau et al. (2010) Guinan et al. (2002) Nandrup-Bus. (2010) Morton Schultz (2004) used reviewing document as instrument. Otherwise, several hand washing promotion instrument used by Luby et al. (2005) Rosen et al. (2009) Zain (2010). Furthermore, studies from Judah et al. (2009) Thumma et al. (2009) respectively, used wireless devices and self report as the instrument. Another four studies used more than one instruments. Asiedu et al. (2011) used combination between questionnaire and structure observation check list, Vessey et al. (2007) mixed between several hand washing promotion and reviewing document, Larson et al. (2004) combined between structure observation check list and self reported diary, Nandrup-Bus (2011) used questionnaire and reviewing document a nd Tousman et al. (2007) mixed multiple instruments such as training devices, handout, reviewing document and structure observation check list. As opposite, studies conducted by Arfianti (2010) did not mention what type of instrument used.As additional, all studies have explained about the ethical consideration. It is very important because the main objective of the morals of research is to provide optimum protection to the subject of research (Sastroasmoro Ismael, 2008). master(prenominal) resultWith regard to documenting outgrowth measure, in all 28 studies reported several outcomes measure, respectively, hand washing compliance, absenteeism rate, hand washing frequency, illness symptom, soap usage, glove usage, number of colonies, presence of hand washing supplies, hand washing disinfectant consumption and some of the studies used more than one type of outcome measure. Not only outcome measure, but also variables identified from all 28 studies.Eight studies used hand washing c ompliance for outcome measure (Vivas et al., 2008 Quintero et al., 2009 Drankiewich Dundee, 2003 Larson et al., 2004 Larson Lusk, 2006 Yuhanna, 2010 Arfianti, 2010 Zain, 2010). Seven studies used absenteeism rate as outcome measure (Vessey et al., 2007 Lau et al., 2010 Guinan et al., 2002 Nandrup-Bus, 2011 Nandrup-Bus, 2010 Tousman et al., 2007 Morton Schultz, 2004). Each of these two studies used soap usage (Curtis et al., 2001 Judah et al., 2009), hand washing frequency (Park et al., 2010 Snow et al., 2008), and illness symptom (Luby et al., 2005 Thumma et al., 2009). Each one a study that used glove usage (Fuller et al., 2011), number of closure (Dunn et al., 2002), presence of hand washing supplies (Ramos et al., 2010) and hand disinfectant consumption (Sjoberg Eriksson, 2010). whatsoever of the studies used more than one type of outcome measure. Asiedu et al. (2011) mixed hand washing practice and presence of hand washing facilities and supplies become outcome measure. In other hand, Rosen et al. (2009) combined belief, attitude, knowledge and self efficacy of preschool pedagogue as outcome measure and Aslan et al. (2006) used level of knowledge and hand washing practice become outcome measure.According to 28 studies reported several variables that influenced hand washing treatment, respectively demography variable include age, education level, social norms and social status, quality of hand washing variable, tinge of improper hand washing, insufficient of hand washing facilities or unsatisfactory hand washing supplies, social support or social relationship and hand washing barriers.In eight intervention studies (Luby et al., 2005 Vessey et al., 2007 Lau et al., 2010 Guinan et al., 2002 Nandrup-Bus, 2011 Nandrup-Bus, 2010 Ramos et al., 2010 Morton Schultz, 2004), the study group was divided into one experimental and one control group. Rosen et al., (2009) and Aslan et al., (2006) have a one group experimental. Two studies (Sjoberg Eriksson, 2010 Zain, 2010) used pre test and post test questionnaires, whereas Snow et al., (2008) used one control group, two intervention group and post intervention questionnaires.As the best of my literacy, there are both consistency finding and inconsistency finding highlight among 28 studies. According to variable demography, namely gender reported consistent that female were more likely to practice more frequent hand washing (Park et al., 2010 Thumma et al., 2009). Otherwise, Lau et al. (2010) Guinan et al. (2002) Nandrup-Bus, (2011) Nandrup-Bus, (2010) Tousman et al. (2007) Morton Schultz, (2004) explained that intervention group has fewer episodes of sickness absence and fewer sickness solar day than control group. Its become inconsistency finding because as opposite Vessey et al. (2007) state that no significant differences were noted between the groups, indicating that the number of student absence was not appreciably affected by the hand cleansing technique used. Based on the import ant inconsistency finding of this study suggesting meaning for further studies in order that focus on absenteeism rate affect by hand washing action.LimitationFrom 28 research articles, several limitations have been founded, explicitly or implicitly, single or multiple limitations. Several single limitations have to consider when interpreting the studies. First, limitation in approach system used (Curtis et al., 2001 Judah et al., 2009 Park et al., 2010 Vessey et al., 2007 Drankiewich Dundes, 2003 Larson et al., 2004). Curtis et al. (2001) stated that structured observation has limitation as a method of collecting data about human behaviour. Second, sample size and homogenous sample (Dunn et al., 2002 Sjoberg Eriksson, 2010 Yuhanna, 2010 Zain, 2010). Dunn et al. (2002) informed that small number of manual wash hand basins available for the project become limitation of the study. Third, Quintero et al. (2009) explained that instrument, namely questionnaire has any bias toward over reporting of proper behaviors. Fourth, out come variable from the studies (Larson Lusk, 2006 Morton Schultz, 2004). Morton Schultz (2004) stated that the outcome variable, absenteeism related to infectious illness could be perceived as bias in measurement because the school nurse served as data collector for the study. Fifth, 8 researchers were not clearly describe limitation in their studies (Luby et al., 2005 Asiedu et al., 2011 Nandrup-Bus, 2011 Rosen et al., 2009 Nandrup-Bus, 2010 Aslan et al., 2006 Snow et al., 2008 Thumma et al., 2009).In other hand, 7 researchers stated that in their studies have more than one limitation (Vivas et al., 2008 Fuller et al., 2011 Lau et al., 2010 Guinan et al., 2002 Tousman et al., 2007 Ramos et al., 2010 Arfianti, 2010). Vivas et al. (2008) stated that in their study there are several limitations toward to approach system, sample, and study design. Whereas, Arfianti (2010) explained that there are two limitations, namely sample and instrume nt in her study.Only five studies that explain the conceptual framework used (Park et al., 2010 Morton Schultz, 2004 Tousman et al, 2007 Yuhanna, 2010 Zain, 2010), whereas 23 researchers did not explain the conceptual framework that used as the basis on their studies.Critically analyzeBased on the stocky above, it will further be explained more specifically that gaps are found. The discussion will be divided into three sections gap in knowledge and gap in conceptual framework.Gap in knowledgeTo the best of my knowledge, gap in knowledge found among others in objective and outcome variable. On the objective, all interventions have been prepared previously by the researchers. In this case, participants implement something planned by the researchers. Similarly, when the studies conducted in community setting (Curtis et al., 2001 Judah et al., 2009 Luby et al., 2005 Dunn et al., 2002). Curtis et al. (2001) evaluated whether the governments program of effective to behaviour change. Ot herwise, Judah et al. (2009) determine effectiveness at increasing hand washing with soap in a natural setting. Moreover, Luby et al. (2005) assess the effect of hand washing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea. Thus, all done by researchers have developed previously without the involvement of community to decide for themselves what they need. Fallen Dwi (2010) expressed how important and strategic working together with the community