{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T07:06:59Z","timestamp":1779001619249,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    Nitrous oxide (N\n                    <jats:sub>2<\/jats:sub>\n                    O) is ozone-depleting and a greenhouse gas. Studies have shown a high wastage of N\n                    <jats:sub>2<\/jats:sub>\n                    O from leaking hospital infrastructure. Identifying leaks is a priority action in the Australian national health and climate strategy. Four possible methods to identify leaks have been described: the discrepancy method, cylinder weighing, pressure testing, and flow monitoring. We used the discrepancy and pressure testing methods to investigate possible N\n                    <jats:sub>2<\/jats:sub>\n                    O leaks at St George Hospital, a large tertiary hospital in Sydney providing medical, surgical, birthing, paediatric, and trauma care. Our investigation was in four steps: (a) to determine how much N\n                    <jats:sub>2<\/jats:sub>\n                    O is procured and calculate the associated carbon emissions; (b) to outline the location of pipeline supply; (c) to determine how much N\n                    <jats:sub>2<\/jats:sub>\n                    O is used clinically (operating theatres, delivery suite, other areas); and (d) to assess for leaks throughout the pipeline using pressure testing. We estimated a total annual \u2018worst case\u2019 estimate of maximum possible clinical N\n                    <jats:sub>2<\/jats:sub>\n                    O use of approximately 801,866 litres at St George Hospital in 2021, with 14,846 litres used in the operating theatres and 787,020 litres used in the delivery suite. This estimate was approximately 319,534 litres (or 28%) less than the 1,121,400 litres procured N\n                    <jats:sub>2<\/jats:sub>\n                    O used to supply the manifold, indicating leaks at least this large. Pressure testing of the full manifold system identified leaks in three operating theatres. A substantial amount of the N\n                    <jats:sub>2<\/jats:sub>\n                    O procured by St George Hospital is leaking to the atmosphere causing unnecessary emissions. This N\n                    <jats:sub>2<\/jats:sub>\n                    O provides no benefits to clinical care, has financial costs, and may pose potential occupational exposure risks to clinicians.\n                  <\/jats:p>","DOI":"10.1177\/0310057x251379095","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T07:33:03Z","timestamp":1765438383000},"page":"235-242","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating nitrous oxide leaks at St George Hospital: A case study using the discrepancy and pressure testing methods"],"prefix":"10.1177","volume":"54","author":[{"given":"Rebecca","family":"Cregan","sequence":"first","affiliation":[{"name":"NSW Ministry of Health Climate Risk and Net Zero Unit, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-3217","authenticated-orcid":false,"given":"Kristen","family":"Pickles","sequence":"additional","affiliation":[{"name":"Wiser Healthcare Research Collaboration, The University of Sydney,\u202fSydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philomena","family":"Colagiuri","sequence":"additional","affiliation":[{"name":"Wiser Healthcare Research Collaboration, The University of Sydney,\u202fSydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"McAlister","sequence":"additional","affiliation":[{"name":"Wiser Healthcare Research Collaboration, The University of Sydney,\u202fSydney, Australia"},{"name":"The Healthcare Carbon Lab, University of Melbourne, Parkville, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-9072","authenticated-orcid":false,"given":"Forbes","family":"McGain","sequence":"additional","affiliation":[{"name":"Wiser Healthcare Research Collaboration, The University of Sydney,\u202fSydney, Australia"},{"name":"The Healthcare Carbon Lab, University of Melbourne, Parkville, Australia"},{"name":"Departments of Anaesthesia and Intensive Care, Western Health, Victoria, Australia"},{"name":"Department of Critical Care, University of Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0137-3218","authenticated-orcid":false,"given":"Katy","family":"Bell","sequence":"additional","affiliation":[{"name":"Wiser Healthcare Research Collaboration, The University of Sydney,\u202fSydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15579"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006620"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X19836104"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Chakera A. Driving down embedded emissions from medical nitrous oxide. BMJ 2021; 375: n2922. doi10.1136\/bmj.n2922","DOI":"10.1136\/bmj.n2922"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Intergovernmental Panel on Climate Change. Climate Change 2013 \u2013 The Physical Science Basis: Working Group I Contribution to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Stocker TF Qin D Plattner G-K et al. (eds) Cambridge University Press; 2014. https:\/\/doi.org\/10.1017\/CBO9781107415324","DOI":"10.1017\/CBO9781107415324"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16086"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191811567"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(20)30271-0"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X241262796"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.08.021"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4103\/sja.sja_791_23"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.08.028"},{"key":"e_1_3_2_14_2","unstructured":"Smith E Mitchell C. The importance of tackling leaks in nitrous oxide pipes. ANZCA Bull 2023; 32: 58\u201359. search.informit.org\/doi\/pdf\/10.3316\/informit.981057534657403. (accessed 06 May 2025.)"},{"key":"e_1_3_2_15_2","unstructured":"Australian Government Department of Health and Aged Care. National Health and Climate Strategy. 2025. https:\/\/www.health.gov.au\/resources\/publications\/national-health-and-climate-strategy?language=en (accessed 6 May 2025)."},{"key":"e_1_3_2_16_2","unstructured":"Kayak E McGain F Burch H et al. Detecting and reducing nitrous oxide leaks in healthcare facilities: a practical guide. Interim Australian Centre for Disease Control Department of Health and Aged Care. 2025. https:\/\/www.health.gov.au\/sites\/default\/files\/2024-09\/detecting-and-reducing-leaks-from-nitrous-oxide-in-healthcare-facilities-a-practical-guide_0.pdf (accessed 6 May 2025)."},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/ad7c6a"},{"key":"e_1_3_2_18_2","unstructured":"BOC Medical Gases. Cylinder identification pocket guide. 2025. https:\/\/www.boc.com.au\/shop\/en\/au\/cylinder-information?srsltid=AfmBOoqMBxR03_zth_rSBpbWETNmKu2Bht9LTr2Wgeoy_0Ju5rE0sHt5 (accessed 6 May 2025)."},{"key":"e_1_3_2_19_2","unstructured":"Standards Australia. AS 2896:2021 Medical gas systems \u2013 Installation and testing of non-flammable medical gas pipeline systems. 2025. https:\/\/www.standards.org.au\/standards-catalogue\/standard-details?designation=as-2896-2021 (accessed 6 May 2025)."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.05.022"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.10.021"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X231198123"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16309"},{"key":"e_1_3_2_24_2","unstructured":"Metro North Health Queensland Government. 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MyHospitals: St George Hospital NSW. 2025. https:\/\/www.aihw.gov.au\/hospitals\/my-local-area-hospital\/h0038 (accessed 6 May 2025)."},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.04.022"}],"container-title":["Anaesthesia and Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X251379095","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0310057X251379095","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X251379095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T06:20:36Z","timestamp":1778998836000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0310057X251379095"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/0310057X251379095"],"URL":"https:\/\/doi.org\/10.1177\/0310057x251379095","relation":{},"ISSN":["0310-057X","1448-0271"],"issn-type":[{"value":"0310-057X","type":"print"},{"value":"1448-0271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}