The Nitrous Oxide Project: #nixthenitrous

Alifia Chakera, part-time Master of Public Health alumni, explains her career progression toward climate change in healthcare, and how she began the journey.

By @Alifia Chakera, Pharmacist and Climate Activist

It was whilst undertaking my part-time Master’s in Public Health (MPH) that I became sensitised to the impact of climate change on global health and our relative inaction to the problem. Within the three years of my MPH programme atmospheric CO2 increased from 407 to 414 parts per million, showing little signs of plateauing and causing extreme climate instability threatening planetary eco systems.

This crisis requires deep changes in our personal and working life; the health sector for instance rivals the aviation sector in terms of its carbon footprint. As such, when I joined NHS Lothian I was determined to drive through an agenda of sustainability.

I have facilitated many carbon saving initiatives within NHS Lothian; but the work that has defined my time with the University of Edinburgh is the novel understanding I have brought to anaesthetic nitrous oxide mitigation.

Nitrous oxide is a potent greenhouse gas and ozone depleting substance, it persists in the environment for over 121 years, destabilising our climate for several generations. Within the UK, anaesthetic nitrous oxide emissions are comparable to 320,000 flights from London to New York and it constitutes over 80% of the total anaesthetic gas carbon footprint.

My dissertation researched opportunities to mitigate this agent and led to the development of an alternative hypothesis: that anaesthetic use of nitrous oxide was low, and that system waste was a significant problem. Within Lothian this nitrous oxide waste theory has been tested and proved correct and is now changing policy in the way we supply and manage this agent.

Nitrous oxide waste has demonstrated to be profound, driven by overspecification and deficits in NHS site capacity to manage these systems. By 31 March 2021, 16 sites had reported on piped nitrous oxide waste across the UK and Republic of Ireland (ROI) to an annual magnitude of 13.7 million litres – equating to 95% of the total annual volume turnover.

I have been promoting my lean implementation framework through the national nitrous oxide project. What I have learned and am trying to convey to clinicians, facilities and procurement teams is that leadership should be collaborative and distributive and problem clarification rigorous to design the most appropriate solutions. Additionally, it is not sufficient to minimise waste within acute sites but examine the opportunities that completely mitigate emissions of this agent across the entire supply chain including addressing damaging industrial policy specifying the venting of nitrous oxide cylinders to the environment prior to refilling.

This work is now embedded into the Greener NHS programme, and being promoted within the devolved nations and the ROI with the support of the Association of Anaesthetists Environmental Champions Network. There is still much to do, but if my policy recommendations and implementation plan are actioned correctly, I believe we have the ability to achieve zero-emissions of this agent within the next five years.