Objectives: The objectives of the study were to evaluate the infrastructural setup for Bio-medical waste (BMW) handling, segregation and mutilation at the point generation of the waste and to identify the shortcomings in the execution of the same in a tertiary level hospital in Udaipur, Rajasthan (India) in the month of September and October, 2021 with the help of a standard checklist with 22 questions and scoring out of 22. Background: Establishing policies and ensuring its effective execution

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... in a hospital are two completely different goals to achieve, when it comes to biomedical waste (BMW) handling, segregation and mutilation. The careless handling of BMW has a potential to become a major health hazard affecting community especially health workers. This study is a critical reminder that the protocols for BMW handling should be followed efficiently and in a strictly monitored environment to achieve the ideal management of BMW. There is always an enormous scope to know about the challenges faced in day to day execution of biomedical waste disposal. Methods: The cross-sectional study was conducted quantitatively among 17 specialties and 5 clinical labs in a tertiary level hospital in Udaipur, Rajasthan (India) in the month of September, 2021 to October, 2021.The approach followed in this study was that, a standard checklist of 22 questions was prepared keeping in mind the regulations related to BMW. Each response appropriate according to Bio-Medical Waste (Management and Handling) Rules, 2016 was denoted in scoring as 1, otherwise as 0. So, the scoring was done out of 22. Data was further interpreted by graphs and percentages, and the outcomes were subsequently analyzed. Results: Results included major problems such as-failure of mutilation of intact needles, failure to follow color coding, uncovered bins, poor hygiene, absence of particular color coded bins, unattended blood bags and failure to segregate in few of the places. Among the poorest scoring specialty includes Neurology outpatient department (OPD), COVID OPD (swab sample collection room), Dialysis treatment room, Neuroscience semi deluxe ward and sample collection room. Conclusion: This is an example of a study conducted to evaluate the condition of hospital waste management in a tertiary level hospital. There is a further scope to study about the knowledge and practices of BMW Management among health workers to identify where these shortcomings in the execution stem from. Further, studies like this should be conducted in large numbers among health care workers and tertiary level hospitals to know the real status of BMW disposal system in order to improve the quality of waste management.