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 (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.