The Royal United Hospital in Bath is reducing its emissions thanks to a staff-led project to decommission its entire nitrous oxide gas pipeline system.

The team who worked to deliver the project | Photo © RUH
Nitrous oxide has been used in hospitals for over 175 years as part of anaesthesia but it is a potent greenhouse gas, estimated to be nearly 300 times worse than carbon dioxide for the environment.
A significant proportion of the nitrous oxide emissions at older NHS hospitals is due to waste from manifolds and the associated old pipework.
The RUH Nitrous Oxide Working Party, made up of medics, estates staff, porters and sustainability experts, started surveying the N2O use in 2022 and discovered that routine N20 orders far exceeded what was needed.

The manifold system at the RUH which has been removed | Photo © RUH
The group led the RUH Trust in decommissioning three cylinder manifold systems and replacing them with portable N2O cylinders to be used in all theatres.
They trained 75% staff to use the portable cylinders in three weeks in time for all three manifolds to be decommissioned.
This simple switch has cut emissions by 2%, equivalent to a SpaceX Falcon 9 flight to the international space station, and will save the trust £7,000 a year.
For mothers in labour, Entonox, otherwise known as “gas and air”, is still readily available for those that need it.
Abigail Mann, Clinical Fellow in Anaesthesia at the RUH, said: “Anaesthetic gases currently make up 2% of the NHS’ carbon footprint and N2O is responsible for a 80% of this, so it has been brilliant working alongside so many different colleagues at the RUH whose expertise and energy has helped to make this switch to a more environmentally friendly way of working so seamless.”
Brian Johnson, Director of Estates and Facilities at RUH, added: “This is a really positive step forward in our efforts to reduce our carbon footprint at the RUH.
“Changing behaviours is critical to the success of many of our sustainability projects so I wanted thank everyone at the Trust who have demonstrated real enthusiasm and interest in progressing our ambitions to reducing our carbon footprint as rapidly as possible as we work towards net zero carbon by 2045.”