Funding from the Small Business Research Initiative (SBRI) Centre of Excellence and Welsh Government Health Innovation, has enabled clinical teams across Wales to co-develop an award-winning innovation that reduces harmful emissions of Nitrous Oxide and Entonox, moving NHS Wales closer to their 2030 net zero target whilst ensuring appropriate pain relief for birthing mothers.

Background

The Healthcare Without Harm Report showed that 5.6% of UK emissions are from healthcare. The Welsh Government declared a climate emergency and published NHS Wales Decarbonisation plan stating that the Welsh public sector will be carbon neutral by 2030. This ambitious plan specifically targets anaesthetic gases and includes nitrous oxide which has a global warming potential approximately 298 times that of carbon dioxide.

Consultant anaesthetist Charlotte Oliver and Pharmacy Manager Elaine Lewis at the Cardiff and Vale University Health Board are both passionate in their commitment to the Wellbeing of Future Generations Act (2015) and playing their part in helping the Welsh Government reach their net zero target through several projects and initiatives, supporting the NHS in their ambition to deliver more sustainable healthcare.

One of those projects was the Nitrous Oxide Project that aimed to reduce the health board environmental and financial impact by supplying anaesthetic nitrous oxide gas to wards by portable cylinders instead of the older piped systems, saving around 1 million litres of nitrous oxide per year, the equivalent to 535 tonnes of CO2.

The Challenge

Building on the success of that project, they contacted the SBRI Centre of Excellence with a challenge; despite streamlining to smaller nitrous oxide cylinders that were proven to be more efficient, they still consumed large amounts of Entonox (50% oxygen, 50% nitrous oxide) which is predominantly used by women for pain relief in labour. When this gas is used, it is exhaled largely unmetabolized into the atmosphere. They wanted to find a solution that would provide a competitively priced and affordable solution to reduce harmful nitrous oxide emissions and improve air quality in the delivery rooms on labour wards.

In November 2022, the SBRI Centre framed an open call SBRI Challenge to industry and academia, offering Welsh Government backed funding for innovative solutions that would lead to the ‘Safe and Ethical Disposal of Nitrous Oxide and Entonox Medical Gases’.

The Solution

Following a competitive selection process, contract funding for the development of the N2O Clear machine was awarded to e-Breathe in Belfast, NI.  Work started in early 2023, with early feasibility through to full design and build of a working prototype. The Pan-Wales Project Team was managed by the SBRI Centre, providing regular clinical input and guidance to the supplier over 18 months of development to create a bespoke, fit-for-purpose solution, and in August 2024 the machine was delivered for performance testing at Betsi Cadwaladr UHB before being transported on to the University Hospital of Wales in Cardiff for further trials.

N2O Clear destroys >99% of exhaled nitrous oxide, converting it into environmentally benign molecules nitrogen and oxygen. The machine has been certified for both UK and EU use, having undergone rigorous EMC, electrical and mechanical testing and has been awarded UKCA and CE Marking.

Thanks to careful input from the team, the product is simple to use, quiet and is energy efficient, with low running costs, and has been designed to be easy clean for infection prevention. It’s also manufactured with end of product life sustainability in mind – the design comprises over 80% recyclable materials.

Responses

Staff and patients alike have responded enthusiastically to the machine, citing both the positive impacts to the environment and their own wellbeing, as well as delivering improved patient care and sustainable pain relief. The project has promoted conversations about reducing the NHS carbon footprint, raising awareness, and fostering a positive attitude towards sustainable healthcare and the benefits to all.

In October 2024, e-Breathe won the INVENT 2024 Green Horizons Award, Organised by Catalyst with headline partner Bank of Ireland, INVENT celebrates ‘our most exciting entrepreneurs’ for the development of the N2O Clear.

Charlotte Oliver, Project Lead, said “The support from Faye, Lynda and the whole SBRI Team was outstanding. I have never managed a project of this scale, ambition or funding level before and I personally have learnt so much from this experience. I felt apprehensive at the start of the project, but have been so well supported throughout the project. We have achieved exactly what we set out to do and believe that there will be lasting change in the way the NHS mitigates its scope 1 Carbon Emissions as a result of this project. This project has exceeded my expectations, SBRI is a fantastic resource for NHS Wales in developing future services.”

Next Steps

The product has already attracted positive attention from health boards and distributors; the team are planning next steps in regards to scale and spread across Wales and further afield, exploring opportunities for collaborative trials elsewhere in the UK.

David McLaughlin, Director of e-Breathe Ltd said “Working with the SBRI team has provided immensely valuable access to real-life users who could help shape the product development to meet their genuine needs. This project has opened up the potential to take the developed product through to full commercialisation, including marketing, manufacturing, sales and servicing. It also provided a route to trial the product within the NHS which would otherwise have been unattainable for us a small company. “