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‘Greet with NAMASTE, bye-bye handshake’: a behavioural change campaign for infection prevention in the Emergency Department from Jodhpur, India
  1. Satyendra Khichar,
  2. Maya Gopalakrishnan,
  3. Gopal Krishana Bohra,
  4. Mahendra Kumar Garg,
  5. Sanjeev Misra
  1. All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  1. Correspondence to Professor Mahendra Kumar Garg, Department of Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India; mkgargs{at}

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To the Editor,

Cross-infection by healthcare workers (HCWs) with contaminated hands is a major source of spread of infection. Transmission or prevention, it all remains in the hands. In this COVID-19 pandemic, greeting with a handshake is no longer acceptable socially or medically. In February 2020, we initiated the ‘NAMASTE CAMPAIGN’. ‘NAMASTE’—greeting with folded hands, an ancient Indian cultural practice means ‘The divine in me bows to the divine in you’. It spreads positivity but not infection, which is essential for mental fitness of emotionally strained HCWs in the pandemic.1 Our centre is an 800 bedded tertiary care hospital in Rajasthan, India, catering to a population of 12 million. Daily flow is approximately 1500 patients at outpatient and 200 at Emergency Department (ED). The ‘NAMASTE CAMPAIGN’, which began in the ED, was committed to achieving a HANDSHAKE-FREE hospital. The campaign included a document highlighting the importance of hand hygiene and benefits of NAMASTE, awareness meeting for HCWs and display of posters at prominent sites of the hospital (figure 1). The general population and patients were involved by using print, social media and banners in the hospital. Their behaviour was further reinforced by welcoming them with a NAMASTE at hospital premises.

Figure 1

(A) Poster displayed for the Namaste campaign. (B) Healthcare worker in personal protective equipment performing namaste gesture.

All this was in place before the very first case of COVID-19 in India. Thirteen weeks after the campaign, we have managed 176 patients with COVID-19 and had a single case of COVID-19 in HCWs. Namaste has fit well into our hospital’s culture. A survey among HCWs in the ED conducted 11 weeks after the campaign revealed 91% followed hand hygiene measures according to protocol while 52% were practising ‘Namaste’. Those following Namaste agreed that it resulted in a positive experience.

Greeting, an essential part of communication should not be avoided during COVID-19 era. The end of handshakes should not mean an end of greeting. Social distancing is reported to have an adverse impact on mental well-being.2 Namaste maintains the physical distancing but helps to prevent social distancing.3



  • Handling editor Ellen J Weber

  • Contributors SM and MKG designed the campaign. GKB, MG and SK were responsible for implementation of infection control and hand hygiene at the COVID-19 screening zones and ED. MG and SK were responsible for reinforcement visits and feedback collection after the campaign. The manuscript draft was written by SK and MG. It was reviewed critically for content and edited by GKB, MKG and SM. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.