Teams working at Cardiff and Vale University Health Board (UHB) have recently unveiled an innovative advancement in sustainable healthcare: the installation of a ground-breaking nitrous oxide “cracker” machine within the maternity unit at the University Hospital of Wales. This cutting-edge technology, developed in partnership alongside industry partner, E-Breathe, and supported by funding from Welsh Government’s Small Business Research Initiative (SBRI) is set to revolutionise how hospitals manage medical gases, aiming to substantially reduce environmental footprints without compromising patient care or comfort.
Entonox, a mix of nitrous oxide and oxygen, commonly known as “gas and air”, is a vital resource in healthcare settings, particularly for providing pain relief to women in labour. Despite its essential role, the aftermath of its use poses environmental challenges. Exhaled nitrous oxide is a powerful greenhouse gas, contributing significantly to climate change. In fact, the emissions from Entonox represent about 75% of all the Carbon dioxide equivalent (CO2e) from anaesthetics in Cardiff and Vale UHB
The newly installed machine, called a nitrous oxide “cracker” operates by chemically dismantling the nitrous oxide into harmless nitrogen and oxygen (the main components of normal air), after the gas has been used to provide pain relief to the patient and they have exhaled it, effectively slashing healthcare-related emissions while ensuring patient care is not compromised.
Dr Charlotte Oliver, a consultant anaesthetist who has been a driving force in this initiative, shared her excitement about this technological feat: “Our aim has consistently been to diminish waste and emissions. The cracker is not just a machine; it symbolises our commitment to sustainable practice and represents a crucial leap forward in reducing harmful emissions.”
The project was initiated as part of a broader effort by Cardiff and Vale UHB and the wider NHS Wales system to make healthcare practices more sustainable. Following the successful shutdown of nitrous oxide manifolds at UHW, University Hospital Llandough and other parts of the Cardiff and Vale UHB estate, many other hospitals across Wales learned from Charlotte and her team and quickly followed suit.
This was an early stage of the project, and the team quickly moved towards implementing more advanced solutions. This shift was greatly influenced by the insights gained from the Spread and Scale Academy, a programme designed to bolster innovation across various sectors.
“The Spread and Scale Academy was transformative for us,” Charlotte reflected. “Before participating, the scope of implementing such a significant change felt daunting. The Academy provided us with both the confidence and the practical tools necessary to bring our vision to life. I had complete faith that we could achieve something. We joined with the idea of shutting down the old leaky manifolds but the Academy taught us to focus more on the problem than our proposed solution, so tackling the waste from Entonox was our natural next step.”
The Academy’s collaborative approach enabled a diverse team of clinicians, pharmacists, estate managers, and engineers to come together to tackle this problem. This multidisciplinary approach was instrumental in implementing practical solutions that could be realised in real-world healthcare settings.
The bid to tackle the emissions from Entonox was supported by the SBRI as a challenge fund project. The challenge moved through several phases, each with an additional sum of funding attached to firstly test feasibility and then develop and implement a viable solution. An initial competitive selection process chose, E-Breathe, a Northern Irish company to develop the prototype. The focus on UK manufacturing was not just about economic benefit but underscored a commitment to sustainable practice.
After successful user testing and feedback collection, the “cracker” is now actively used in the maternity unit and has been met with positive responses from both healthcare professionals and patients. This pilot phase also has the potential to encourage further adoption across the healthcare sector in the UK. The nitrous oxide cracker represents a landmark achievement not only for Cardiff and Vale UHB’s Nitrous Oxide team, but also for broader healthcare sustainability practices. Its success is anticipated to lay the groundwork for wider commercial rollouts and collaborations beyond Cardiff, aligning with the NHS’s and Welsh Government’s overarching sustainability ambitions.
Charlotte adds: “This project is more than just about reducing emissions; it’s about a new way of thinking in healthcare sustainability. The success of this initiative could inspire countless other organisations to take proactive steps in combating climate change.”
Faye Williams, SBRI Project Manager said, “I am really proud to have been able to deliver this project on behalf of the SBRI Centre of Excellence. Charlotte and her team at Cardiff have been wonderful to work with and the unique collaboration with CVUHB along with colleagues from NWSSP, Betsi Cadwaladr University Health Board and of course David at E-Breathe has seen this idea go from concept to reality. To see the final prototype in use at Cardiff is great as it shows what we have been able to achieve, and I hope this can have a wider impact across Wales and beyond”.
David McLaughlin, CEO of e-breathe, said, “This innovative product provides a sustainable way for mums to get the pain relief they require during childbirth and provide a more comfortable work environment for midwives – as such it ticks a lot of boxes for us at e-breathe as an integral part of our vision to provide more sustainable healthcare. Working with the SBRI and clinical teams at UHB has provided immensely valuable access to real-life users who could help shape the product and also a route to trial the product. The collaboration has been a pleasure.”
Suzanne Rankin, Chief Executive of Cardiff and Vale UHB, said, “I extend my heartfelt gratitude to all our colleagues for their tireless efforts in advancing sustainable healthcare. Your dedication to innovation and sustainability exemplifies what we can achieve together. Through the spread and scale of ground-breaking innovations like the nitrous oxide cracker, we are taking significant steps towards minimising our environmental impact while maintaining high standards of patient care. This commitment to sustainability not only benefits our community today but also ensures a healthier tomorrow for future generations.”
