Healthcare Waste (HCW) is a special waste produced in healthcare institutions, including hospitals. It has a high potential for infection and injuries. The issue of waste disposal is growing as the number of hospitals, clinics, and diagnostic laboratories in Nepal continues to increase. The study aimed to assess the adherence to healthcare waste management (HCWM) practices and knowledge among waste handlers at the government district hospitals of Madhesh Province of Nepal which lies in the southern part of the country. A cross-sectional mixed-method study design was employed to assess the adherence of healthcare waste management practices and knowledge of healthcare waste management guideline among HCW handlers from 10 district-level hospitals in Madhesh Province. We developed a semi-structured questionnaire from Nepal's National HCWM Guideline 2014 and the World Health Organization HCWM Rapid Assessment Tool 2011, to interview 60 HCW handlers for quantitative information. Then 10 key informant interviews were conducted using KII guidelines with related stakeholders of district hospitals of Madhesh Province. A four-point Likert scale was used to assess the practices and knowledge of HCW handlers and health facility-related factors. Descriptive data analysis was presented in tables for frequency, percentage, mean, and standard deviation, and correlation was presented in Graphs. A thematic analysis was performed for qualitative data by using RQDA and discussing the findings before concluding the study. Among the sixty participants, the median age was thirty-five years while thirty percent were less than the median age. Among total participants, the majority of female were 65% and almost all of them (96.67%) were married. The majority (65%) were females and almost all (96.67%) were married. About one-third (36.67%) of participants were illiterate. Most of the participants had experience of 5 to 10 years. The mean adherence of HCWM was 74.88±9.66 SD. Among the participants, half of them had adequate knowledge while the median knowledge of HCWM was 39 and the inter-quartile range was 5 (q3 = 41, q1 = 36). The mean of the HCWM practice was 24.18±5.96. The median of health facilities-related factors was 13 and the interquartile range was 3 (q3 = 15 and q1 = 12). The full adherence to HCWM guideline 2014 was extremely low among healthcare waste handlers. The HCWs had less adequate knowledge of HCWM and they did not practice to manage HCW adequately in district hospitals. However, the hospitals had adequately provided amenities to manage healthcare waste.
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