From hidden emissions to climate leadership: Tackling nitrous oxide in health care

HN Summary

• Nitrous oxide (N₂O), a greenhouse gas nearly 300 times more potent than CO₂, is heavily leaked through outdated centralized hospital systems, with audits showing 70–99% loss — driving avoidable emissions and costs.

• The Canadian Coalition for Green Health Care launched Nix the Nitrous, offering toolkits, cost tools, checklists and webinars to support safe system decommissioning.

• Eliminating centralized N₂O systems can significantly cut emissions, reduce expenses and advance health care’s net-zero and public health commitments.

Climate change is widely recognized as one of the greatest threats to human health and wellbeing this century. The health of people and the health of the planet are inseparable. Yet despite its mission to heal, the health care sector is a significant source of greenhouse gas (GHG) emissions and other environmental impacts—contributing to the very conditions that undermine health and strain health systems. 

Across Canada and globally, hospitals and health organizations are beginning to confront this paradox. From energy use in buildings to supply chains and clinical gases, every aspect of care delivery carries a carbon footprint. One critical opportunity for action is the reduction (preferably elimination) of nitrous oxide (N₂O), a powerful greenhouse gas commonly utilized in health care settings.

N₂O has a global warming potential nearly 300 times that of carbon dioxide and remains in the atmosphere for approximately 114 years. Its long lifespan and high warming potential make even small emissions significant. While once commonly used as an adjunct anesthetic and carrier gas, demand for N₂O has declined considerably with the advent of newer anesthetics and evolving clinical practices. Today, its primary uses are often limited to self-administered conscious sedation during childbirth or pain control in emergency departments.

Despite this reduced demand, many hospitals continue to maintain and operate centralized nitrous oxide supply systems designed decades ago to distribute the gas throughout entire facilities. These systems are notoriously inefficient. Audits conducted in hospitals in Ontario and British Columbia have found that 70–99% of purchased N₂O is lost through leaks in centralized systems. The result is hundreds to thousands of tons of unnecessary emissions per year, along with significant and avoidable financial costs.

In response, many anesthesiologists have already eliminated N₂O from routine clinical practice or moved to portable, point-of-use N₂O tanks, and decommissioning centralized nitrous oxide infrastructure has emerged as one of the most immediate and impactful actions hospitals can take to reduce emissions, cut costs, improve operational efficiency, and mitigate health and safety risks associated with persistent gas leaks.

The Canadian Coalition for Green Health Care is one organization that has stepped in to support this meaningful change. The Coalition exists to advance a more sustainable, climate-resilient, and net-zero health system in Canada—one that protects health by reducing environmental harm and strengthening the sector’s ability to respond to climate-related risks.

As part of its Preparing Canada’s Health Care Buildings for Net-Zero project—made possible with investment from the Government of Canada’s Low Carbon Economy Implementation Readiness Fund—the Coalition has launched the Nix the Nitrous suite of resources and recognition program.

The Nix the Nitrous resources include:

• Nitrous Oxide Toolkit: Central Supply System Deactivation Guideline – A comprehensive guide outlining best practices for emission reduction and equipment decommissioning.

• Nix the Nitrous Checklist – A quick-reference tool to help facility teams assess current N₂O use, identify improvement opportunities, and track progress toward sustainability goals.

• Decommissioning Cost Estimate Tool – A data-driven resource that supports hospitals in planning and budgeting for infrastructure changes required to eliminate unnecessary centralized systems.

• Educational Webinars – National learning events that brought together energy managers, clinicians, and sustainability leaders to share insights and practical experiences in transitioning away from nitrous oxide use.

Together, these resources provide both the technical guidance and strategic rationale needed to support change at the facility level.

Building on this momentum, the Coalition has officially launched the Nix the Nitrous Recognition Initiative, a national program designed to celebrate health care facilities that are taking action to decommission centralized nitrous oxide systems as part of their decarbonization efforts.

The initiative recognizes facilities at every stage of the journey. Whether a hospital is just beginning to assess its N₂O system, actively decommissioning infrastructure, or has fully completed the process, participation offers an opportunity to be recognized for demonstrating leadership while inspiring others. This Initiative aims to accelerate progress across Canada’s health system and help to normalize decommissioning as best practice while building confidence among peer institutions considering similar action.

Participating facilities will be featured on the Coalition’s website and social media channels and may be invited to share their experiences in a webinar, as well as receive a certificate recognizing their leadership and achievements.

Eliminating unnecessary nitrous oxide systems delivers measurable results. Hospitals can dramatically reduce greenhouse gas emissions, improve indoor air quality, enhance system resilience, and lower maintenance and gas procurement costs—all while aligning with Canada’s national net-zero objectives.

Health care exists to protect and improve health. In an era defined by climate change, that mission must extend beyond the bedside to the systems and infrastructure that support care. Decommissioning centralized nitrous oxide systems and going to point-of-use delivery if it’s still needed is not only a practical emissions-reduction strategy—it is a tangible expression of health care’s commitment to “first, do no harm.” 

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