A weighing method for measuring nitrous oxide leakage from hospital manifold-pipeline networks.

Nitrous oxide is a potent greenhouse gas and ozone-depleting agent with a long atmospheric lifetime. Several previous reports indicate that over half of supplied nitrous oxide is wasted from leaking manifold-pipeline systems infrastructure prior to patient use, and that remediating leaks can have significant environmental benefits. We describe an accurate, simple and cost-effective cylinder weighing method to quantify nitrous oxide leak from the manifold-pipeline network at our tertiary non-obstetric facility. Nitrous oxide cylinder depletion was prospectively compared with clinical usage derived from the electronic medical record over an 18-day period. A total of 1932 l (3.62 kg) of nitrous oxide was used in 35 operating theatre cases during the period. This was only 16.5% of actual cylinder depletion (11,686 l; 21.88 kg), indicating that 83.5% (9754 l; 18.26 kg) of nitrous oxide had leaked to the atmosphere (376 ml/minute; 22.6 l/hour; 542 l/day). The fraction of nitrous oxide wasted was consistent with a retrospective analysis of the previous 2-year period at the site that compared purchasing records with estimated clinical use. If maintained over a year, the leak would be equivalent to 101 tonnes of carbon dioxide per annum.

A survey of anesthesiologists' views of operating room recycling.

BACKGROUND: Operating rooms contribute significantly to the increasing volumes and costs of hospital waste. Little is known, however, about doctors' views of hospital waste recycling despite their potential influence in improving recycling programs. We surveyed the waste recycling views held by anesthesiologists in Australia, New Zealand, and England in regional or metropolitan and public or private practice. We asked the following: (1) What proportion of anesthesiologists consider recycling operating room waste to be important? (2) What do respondents consider to be identifiable barriers preventing operating room recycling? METHODS: We performed a Web-based survey of 11 questions of attitudes to operating room waste recycling held by anesthesiologists. After piloting, the survey was e-mailed to 500 randomly selected Fellows of the Australian and New Zealand College of Anesthetists. All anesthetic departments of the National Health Service of England also received the e-mail with a request that English consultant anesthesiologists complete the survey. RESULTS: We received 780 responses from anesthesiologists, 210 (41% response rate) from Australia and New Zealand and 570 (11% response rate at worst) from England. Regardless of location or type of practice, most (725, 93%; 95% confidence interval [CI]: 91% to 95%) responding anesthesiologists would like to increase recycling of operating room waste and would commit their time, but not their money to doing so. Only 87 (11%; 95% CI: 9% to 14%) respondents agreed/strongly agreed that waste recycling occurred in their operating rooms already. Survey respondents thought that the greatest barriers to recycling waste were (1) inadequate recycling facilities, 381 (49%); (2) negative staff attitudes, 133 (17%); and (3) inadequate information on how to recycle waste, 121 (16%). Time, safety, inadequate space for recycling receptacles, and cost were each thought by <5% of respondents to be the greatest barrier to recycling. CONCLUSIONS: Most responding anesthesiologists supported greater operating room waste recycling but thought that there were identifiable barriers. Anesthesiologists could take a leadership role and work with other hospital employees to improve operating room recycling. We suggest studies of the effect of improving operating room recycling facilities, education, and staff attitudes.