A survey of the use of nitrous oxide across health professional groups and their understanding of its environmental impact.

Abstract

Abstract: Nitrous oxide (N2O) is a potent greenhouse gas with a global warming potential approximately 273 times that of carbon dioxide [1] and “now the dominant ozone depleting substance released into the atmosphere” [2]. N2O is recognised as a significant contributor to the carbon dioxide emissions of health services; “N2O alone contributes 2% of the total NHS England carbon footprint, and 75% of the total anaesthetic gas footprint”[3]. We aimed to survey N2O usage patterns, and knowledge of its environmental impacts among multidisciplinary clinical staff at a large metropolitan public health network. Methods: Ethics approval was obtained from the Western Health Low Risk Ethics Panel, Melbourne, Australia (QA 2022.13_85216). An anonymous online survey was distributed via email to doctors, nurses and midwives in anaesthesia, adult and paediatric emergency medicine, paediatrics, and obstetrics. Data were analysed using descriptive statistics in Microsoft Excel. Results: There were 407/1349 (30%) responses, with responses from all groups surveyed. The majority (239/407, 59%) reported that they currently use N2O, with the most common main reason being pain relief (102/239, 43%). Of this group, 184/239 (77%) felt there were alternatives to N2O for the purpose for which they use it, but identified a range of barriers to using alternatives. The vast majority (227/239, 95%) said they either would or might be willing to use alternatives if they are available and practical to use. Approximately half (219/407, 53%) identified that N2O is a greenhouse gas, and 70/407 (17%) correctly identified its global warming potential as hundreds of times that of carbon dioxide. Less than half (180/407, 44%) thought it depleted the ozone layer. Discussion: This survey demonstrated that a significant proportion of healthcare staff working in areas that use N2O don’t know its harmful environmental characteristics, and a potential willingness of healthcare staff to use alternatives if they are available and practical to use. There was a difference between groups; 93% (67/72) of anaesthetic doctors knew that N2O was a greenhouse gas, but only 41% (32/79) of midwives did. These are targets for future intervention and research. Previous surveys have been administered among either anaesthetists or birthing suite staff, but this is the first we are aware of to include staff from emergency departments or paediatrics. Engagement of all clinical areas that use nitrous oxide is crucial to understand its use and devise interventions to reduce this. Multidisciplinary collaboration will also increase the likelihood of success.