“Boutique Waste Man”
WNWN International Inc. is a Health Care Waste Management (HCWM) consulting firm working with all facets Health Care Waste (HCW) – from assessing treatment technologies for different waste streams to developing regulations, policies, and guidelines for countries, to conducting training programs for HCWM practices.
Ed Krisiunas
WNWN (Waste Not Want Not) International, Inc.
I am a medical technologist by education – I was trained to work in a clinical laboratory, where I perform tests on patient samples. I could have worked in chemistry, haematology, blood bank, immunology, serology, or microbiology. I chose microbiology (its associated disciplines and began working in the lab in 1982. That work prepared me to work on Infection Control (1986 to 1989). In 1989, I began my career in the medical waste industry. For the next 12 years, I worked for three different companies (a medical waste treatment plant, a medical waste transport company, and a medical waste mail-back company). During those 12 years, I also obtained my master’s degree in public health (1997).
In 2001, WNWN (Waste Not, Want Not) International was formed. I have been the President of WNWN Int. since its inception. Since I began travelling internationally in 1994, I have visited and worked in >60 countries on a wide range of issues related to HCWM and Infection Prevention and Control.
Boutique Waste was my SKYPE account name. It came to me as I thought about all the colours of bins, bags, boxes across the globe. The one common item on all these items regardless of country – the universal biohazard symbol!
What inspired you/ your organisation to join ISWA, and how has ISWA helped in your career?
The impetus to join ISWA began before the Working Group on Healthcare Waste was formed. I was working with a medical waste firm in England (Polkacrest) that led to consultancies with the Environment Agency and the NHS. It was during that time that I met Bill Townend, a member of the CIWM. We began collaboration with another colleague in Paris (Regis Durand – International Healthcare Waste Advisory Network – IHcWAN). I joined ISWA in 1998 and had the pleasure to work with Bill as well as meet many people across Europe in the ensuing 30 years.
What are your biggest challenges so far?
For many projects on health care waste management in low- and middle-income countries, the recurring challenge is a lack of funding and lack of commitment at a high level (with facility management as well as within government). Equipment is provided with initial training on operation. However, systems are not in place sustain these systems. I have too many stories and photos of bad and ugly versus good practices.
In your opinion, what are the most pressing issues in the waste sector that should be addressed today?
The first is tackling waste management in low-income countries, as this is akin to a forest fire out of control. Solutions must be bold to address the local context challenges, such as replacing waste pickers or improving their utilisation. Second is to address waste creation – we need to better address materials management – the things being discussed in circularity. I am not an expert in this area. I was initially sceptical and, to some degree, remain sceptical as I would like to work more on a specific project addressing circularity to truly understand the nuances.
What are the biggest projects/ initiatives in waste management that your organisation has achieved so far?
My team (made up of some ISWA members) was involved in developing treatment and disposal strategies for a chemical waste stream (Guanidine Thiocyanate – GTC) from HIV Viral Load testing labs in Africa. The project initially began in October 2017. Engagement with the African Society for Laboratory Medicine and the US CDC began in earnest in June 2021 and continued to March 2025. We initially worked and visited with 9 countries (Eswatini, Ethiopia, Kenya, Malawi, Mozambique, Nigeria, Uganda, Zambia, and Zimbabwe) to provide initial training on GTC waste management. This evolved to working with lab staff from 26 countries to provide live training in regional training sessions (Cape Town, Addis Ababa, and Accra), hands-on experience with the treatment methods, and the WNWN team was able to assess. Countries are now implementing treatment programs that work in the local context.
What are the trends in waste management that excite you the most?
As my focus is the healthcare sector, it is exciting to see so many efforts to research and address sustainability in so many facets of the industry. There are groups focusing on lab waste (plastics and chemicals), operating rooms/theatre (packaging, reprocessing and or recycling of single-use devices), diabetes care (recycling of pen devices as well as Continuous Glucose Monitoring (CGM) devices. This is just a sampling of the activity in this space.
What role do you see ISWA play in driving sustainable practices globally?
ISWA has a diverse and extremely knowledgeable talent pool of members from around the world, dealing with issues at a local level and in a local context. This is critical to be able to share this knowledge – the local context as what works in high-income countries does not translate to low- and middle-income countries – and vice versa! Knowledge transfer is as important as technology transfer.
How can ISWA members collaborate more effectively to address shared challenges?
We can collaborate better by working together on waste management issues that transcend our industry. We will have a combined session at the ISWA Congress with the Working Group on Hazardous Waste. Chemicals / Pharmaceuticals / Chemotherapeutic waste is hazardous waste generated in healthcare. We should all be partnering on projects!
ISWA has an active Young Professionals Group as a special task force, what would be your advice to them looking to make a difference in the waste sector?
My advice to the YPG members: When reviewing any articles, always check the references that are listed. My colleagues and I say – Trust but verify! Secondly, if you read a news article that references a scientific paper, obtain the paper …Did the news article do a good job of reviewing the article, or did they miss something? I will also suggest connecting with the authors if they share mutual interests in the work you are both working on. These are networking opportunities. Nothing ventured, nothing gained!
