Biomedical waste management compliance, awareness and practices in a tertiary care hospital: a pragmatic approach

• Mixed-methods study assessed biomedical waste management compliance and awareness. • Observational audits across wards showed > 98% compliance with BMW rules • Minor operational gaps included bin overfilling and blue-category storage issues. • Healthcare personnel showed high awareness (>93%) of segregation and infection risks. • Legal knowledge gaps (<70%) persisted despite strong practical awareness. • Continuous training and monitoring are essential for sustaining BMW compliance. Biomedical waste management (BMWM) is a critical component of healthcare delivery, with improper handling posing risks to healthcare workers, patients, and the environment. Despite regulatory frameworks such as the Biomedical Waste Management Rules, 2016 in India, gaps persist in compliance, awareness, and enforcement, particularly in resource-constrained settings. Evidence integrating institutional practices with legal perspectives remains limited. This mixed-methods study included a prospective observational audit of BMWM practices across hospital wards, a cross-sectional awareness survey among newly inducted healthcare personnel and housekeeping staff, Compliance was assessed using a structured checklist aligned with national guidelines. Awareness was evaluated using pre-validated questionnaires. Descriptive statistics were used to summarize the data, and inferential analysis was performed using the Chi-square test to assess associations between categorical variables. Overall compliance with BMWM practices exceeded 98%, with appropriate segregation, labeling, personal protective equipment use, and waste transport observed across most areas. Limited operational gaps were identified in a small proportion of observations, including bin overfilling in 2 (2.0%) observations, improper blue category waste handling in 2 (2%) observations, and occasional use of non-foot-operated containers or trolleys in 2–3% of wards. Awareness among healthcare personnel was high (>93% across key domains), although knowledge of legal provisions was comparatively lower. Female participants demonstrated significantly higher awareness levels than males (p = 0.014). Housekeeping staff showed good adherence to practical waste-handling practices. High institutional compliance and awareness coexist with operational and legal knowledge gaps. Continuous training, strengthened monitoring, and integration of legal awareness into capacity-building programs are essential to sustain effective biomedical waste management.