A survey of nitrous oxide usage and knowledge of its environmental effects across healthcare worker groups

Nitrous oxide (N₂O) is a greenhouse gas that is a significant contributor to the carbon dioxide-equivalent emissions of health services. We aimed to obtain information about N₂O usage and knowledge of its environmental effects among clinical staff at an Australian metropolitan public health network. We distributed an anonymised survey to doctors, nurses and midwives working in anaesthesia, birthing, adult and paediatric emergency medicine, and paediatrics. We analysed 403 of 1320 (31%) responses; 117 of 198 (59%) from anaesthesia, 102 of 368 (27%) from birthing, 137 of 643 (21%) from adult and paediatric emergency medicine and 40 of 111 (36%) from paediatrics. Descriptive statistics were used, and statistical analyses performed on questions regarding environmental knowledge. Of those who currently used N₂O, the majority indicated there were alternative therapies (184/239, 77%), which they would (137/239, 57%) or could (90/239, 38%) be willing to use. Approximately half (219/385, 57%) of respondents correctly identified N₂O as a greenhouse gas, but only 70/382 (18%) identified its global warming potential as hundreds of times that of carbon dioxide. Almost half (180/383, 47%) answered that N₂O is ozone depleting. For anaesthetists, 96% (45/47) knew that N₂O was a greenhouse gas, compared with 41% (32/79) of midwives. This survey demonstrated that frequency of use and reason for use of N₂O varies between clinical groups, and that a significant proportion of staff that use N₂O do not know its harmful environmental characteristics. Our results provide data to inform future research on interventions to minimise clinical use of N₂O, and suggest that educational programs should form part of these efforts.