Introduction: Medical devices in hospital Intensive Care Units (ICUs) constitute a major investment center. Repair/replacement costs due to mishandling causes revenue drains which are largely avoidable. This study identifies the causes, cost incurred, lag time due to breakdown of medical devices in ICUs due to mishandling and training needs of ICU staff. Methods: This observational study was conducted in a 550-bed hospital in Pune from Jan'2015-May'2016. Records of machine breakdown reports maintained by biomedical department were analyzed for cost incurred due to repair or replacement of devices/accessories/parts. Reasons for mishandling were enquired through questionnaire and short interviews of ICU nurses and biomedical staff. Machine breakdown due to unavoidable incidents were excluded. Further, we prepared Instrument handling guidelines; proposed an ergonomically sound patient bed area; and conducted training of ICU nurses. Subsequently a post training assessment was done. Results: More than INR 4, 66, 000/- worth of accessories/parts/devices were replaced due to device mishandling. Monitors and syringe pumps were most prone to breakdowns due to mishandling. The average time lag for solving a breakdown problem was 24 hours (minimum=5 minutes, max=11 days, 3 hours). The leading causes for mishandling were ignorance, carelessness, lack of training, improper ergonomics and improper placement of devices, stress and fatigue. Post training assessment showed that mishandling incidents reduced to less than 50%. Discussion & Conclusion: Regular training of ICU staff and incorporating ‘Instrument handling guidelines' as a part of induction program for new staff will reduce device mishandling. Unplanned expansions should be avoided and patient bed area should be properly planned.