Main nitrous oxide manifold decommissioned at University Hospital of Wales

The main nitrous oxide manifold at University Hospital of Wales has been successfully decommissioned, marking a huge step in the Health Board’s commitment to reducing carbon dioxide (CO2) emissions. 

Nitrous oxide is commonly used in healthcare for anaesthetics but despite being a critical part of healthcare delivery, it is considered a harmful greenhouse gas. Studies show nitrous oxide has more than 265 times the global warming potential than CO2.  

There are currently four nitrous oxide manifolds across the Health Board’s sites which are the typical method of storage. Findings by a Cardiff and Vale University Health Board’s multi-disciplinary project team have identified wastage from this type of system can be high due to leaks and loss of gas from the supply. 

The Health Board has trialled portable nitrous oxide cylinders at the Children’s Hospital for Wales as part of an individual pilot which has increased efficiency considerably, from 2.5% to 74%. This demonstrates that significant gains are to be made from moving from a piped supply to a portable cylinder supply.  

Following the successful pilot, the team scaled the pilot study across the organisation through The Spread and Scale Academy, with ambitions to share insights and encourage change across Wales. 

Earlier this year, the manifold at the University Hospital Llandough site was fully decommissioned. Now, only two of the four manifolds remain in use, the dental manifold at University Hospital of Wales and a manifold at St David’s Hospital. There is a project underway to explore decommissioning these remaining manifolds. 

The Healthcare Without Harm Report says 5.6% of UK emissions are from healthcare settings and the NHS Wales Decarbonisation plan highlights anaesthetic gases reduction. The Health Board has projected savings of 1.15 million litres of nitrous oxide or 679 tonnes of CO2e each year which will play a huge part in making healthcare more sustainable in Cardiff and the Vale of Glamorgan and beyond.  

The project group are working with Welsh Government and other Health Boards to provide support and advice to clinicians looking to implement this change – helping to reduce the use of nitrous oxide across Wales. 

The next part of this project will review the use of Entonox and engage the Emergency Unit to explore using smaller cylinders. Within maternity services, the team are reviewing the effectiveness of the Entonox Carbon Reduction Units implemented earlier this year, and sharing the results across Wales.  

The project team have been successful in securing Welsh Government SBRI (Small Business Research Initiative) funding and will be working across Wales with other Health Board’s and industry to develop technology to breakdown the gas ensuring it is not released into the atmosphere. Health Boards and Trusts across NHS Wales could potentially adopt this solution.