Interestingly, two out of four studies compared compliance rates of healthcare workers, particularly nurses and doctors. Sharma, Puri, Sharma, and Whig (2011) found in their study that compliance rates with hand hygiene protocols were significantly higher for physicians (50.8%) than nurses (41.3%). In contrast, Mathai, George, and Abraham (2011) had mixed results where higher compliance rates were associated with nurses (45%) compared to physicians (17%). Both studies had similar sample sizes and were studied in developing countries, India and Pakistan; however, language barriers and different education levels of different staff groups may have influenced the understanding of the need for effective hand hygiene (Mathai et al., 2011). Of the four studies, three were observational studies, providing the opportunity to question the rigor of the analysis