More than Compliance is Needed – Open Letter to our Healthcare Colleagues

State based mandates for smoke evacuation have arrived and will continue to expand thanks to the protean efforts of the legislative arm of AORN and the generous financial support from Medtronic aimed at achieving a clean air environment in the nation’s operating rooms. Although compliance to the mandates has priority, so too does consideration for what is purchased to fulfill their requirements so that all shareholders benefit from such legislation. An evaluation of anticipated outcomes from use of such technology has often been lacking despite ISO 16571:2014 guidelines, especially Section 4.3, which recommends a minimal requirement for “effective plume evacuation” in the operating room of 90% “… as documented by the manufacturer.”

In contrast, the miniSQUAIR® has third party data that supports positive patient outcomes based on the following:

  1. 98-99.5% “smoke capture efficiency”1
  2. 100% capture of airborne transmitted bioaerosols.2
  3. Significantly higher capture of ambient air “particulates” in posterior spinal fusion cases versus the ESU “pencil.”3
  4. Significantly higher capture of “aerosols” caused by mechanical drills used in nasal surgeries versus the ESU “pencil.”4
  5. More than a 30% decrease in post-operative infections, both superficial and deep, in posterior lumbo-sacral spinal fusions when the miniSquair® is used versus a comparable group without use of bioaerosol capture technology. Standard surgical protocols, including intrawound antibiotics were used in both groups.5

These data substantiate:

  1. Current technology can Increase protection for the O.R. team from chronic inhalation of nanoparticles present in surgical plume that cause serious systemic diseases.
  2. Because of such protection, there is a potential decrease in the financial liability for future workman compensation claims.
  3. Available technology, when properly used, can decrease post-operative wound infections thereby resulting in significant savings in both cost and morbidity.
  4. In addition, the benefits of a clean air work environment include reduced absenteeism, enhanced work output and improved employee morale.

Taking all of the above into account, you can appreciate the full clinical impact stemming from the consistent use of the miniSQUAIR® bioaerosol capture device.

April, 2022


  1. Olson B., Mgr., Particle Calibration Laboratory, Dept. of Mechanical Engineering, University of Minnesota, December 2, 2013.
  2. Schultz L. Can efficient smoke evacuation limit aerosolization of bacteria? 2015; AORN J. 102(1): 7-14.
  3. Liu N, Filipp N, Wood KB. The utility of local smoke evacuation in reducing surgical smoke exposure to spine surgery; a prospective self-controlled study. 2020; Spine J. 20(2): 166-173.
  4. Sharma D, Ye M, Campiti V, Rubel KE, Higgins TS…Ting JY. Mitigation of aerosols generated during rhinologic surgery: A pandemic era cadaveric simulation. 2021; Otolaryngology Head Neck Surg. 164(2): 433-442.
  5. Kim S, Schultz L. Can capture of surgical smoke decrease post-operative infection rates (SSI): Preliminary report. Poster # 311. Presented at the 18th Annual ISASS meeting, April 11-13, 2018, Toronto, Canada.