Chapter 03: Research into Leukemia: Life Islands and Laminar Air Flow Units
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Description
In this chapter, Dr. Bodey speaks at length about the challenges and innovations he helped pioneer at NCI and MD Anderson. He mentions his research on infections related to neutrophil counts, which is now a standard for antibiotic studies, and a study on fungal infections in acute leukemia patients.
Two major projects he worked on include the “Life Island” and laminar airflow units. The Life Island was a protected environment for immunocompromised patients, using a plastic tent with HEPA-filtered air. The laminar airflow units were high-efficiency particulate air filters designed to minimize infection risks. Each of these innovations faced several challenges, including building infrastructure issues and psychological challenges for isolated patients.
Identifier
BodeyG_01_20030303_C03
Publication Date
3-3-2003
City
Houston, Texas
Interview Session
Gerald P. Bodey, Sr, MD , Oral History Interview, March 03, 2003
Topics Covered
The Researcher; Devices, Drugs, Procedures; Obstacles, Challenges; MD Anderson Product Development and IP; Discovery and Success; On Research and Researchers; Understanding Cancer, the History of Science, Cancer Research
Transcript
Gerald P. Bodey, Sr, MD :
When I was at the National Cancer Institute, I did several studies, one of which was the paper that related the risk of infection to the patient’s neutrophil count. That became a citation classic eventually and has been highly quoted over the years because of the defined risk related to patients’ neutrophil counts, which became sort of a standard for antibiotic therapy. Also at that time, I did a review with one of my other colleagues, Dr. Evan Hersh, who was here for some time. We looked at what patients with acute leukemia were actually dying from, and he was the senior author on that paper, which also became a citation classic. While I was helping him, reviewing the autopsy material and all, I got intrigued by the data on the patients who had fungal infection. I went back and did a review on fungal infection and acute leukemia, and I’m fairly confident in saying this, that it was the first assessment on an organized status of all of the fungal infections in acute leukemia patients in an autopsy series. There were papers that had been done earlier in small groups and focused on one particular kind of a fungus or another. But I think that this was the first really organized study looking at autopsy material. The NCI had autopsies in just about every patient who died of acute leukemia on their service, so it was a large number of cases. That sort of experience got me interested in the whole area of infections in the cancer population. Shortly before I left the National Cancer Institution, Dr. Frei had learned about a device that was designed to protect patients from contamination. It was called the life island, and basically it was a bed surrounded by a plastic tent, and the air that came into the unit was filtered air, HEPA-filtered air. They had an ultraviolet block where you put things in and out, and everything was sterile, and they had sleeves with gloves for you to examine the patient. The patient goes in there, and he’s in there until he’s let out.
Lesley Williams Brunet, CA:
Are the life islands the same thing as the protected environment, or are they slightly different?
Gerald P. Bodey, Sr, MD :
They were the original protected environment. But then the patients were given antibiotics as well, prophylactically, and they would go in there for their treatment of acute leukemia. And so the program started at the National Cancer Institution. Then we all left there, and Dr. Frei had gotten a grant to start that same kind of program here. When I got here, there were two life island units. They were just starting up the program so I was assigned as one of my responsibilities to take that over. About 1969, the NCI contacted us. They were interested in developing a program with laminar airflow models. So we were the first people to use laminar airflow for a patient undergoing cancer chemotherapy. We renovated two of the rooms on the old 3-West unit in the original hospital building into a laminar airflow facility.
Lesley Williams Brunet, CA:
Would you explain what that is in terms of the difference in the life island and—
Gerald P. Bodey, Sr, MD :
Yeah. The life island was just what I said. It was a bed with a plastic canopy around. The air was circulated through, and patients were really quite limited. I mean, they couldn’t go anywhere. We had a patient who stayed in almost a year. I don't know how he tolerated it for so long. The usual length was about ten to twelve weeks, or well, eight to twelve weeks. But what the laminar air flow is that you have one entire wall that is a filtration system of these high-efficiency particulate air filters that filter out 99.95% of particulate matter. The return vent would then be in the ceiling at the opposite side of the room. The idea was that you were having this sort of laminar distribution where ideally a particle in the air started out over here, and would end up at the opposite side of the room. Well, it didn’t really work quite that way, but for much of the transfer of the air across the room, it was in this laminar distribution. This was first developed in Sandia Laboratories in Albuquerque. Willis Whitfield, I think, was the guy who developed it, and we met him several times. There was a company up there called Envirco that had been working with him, so they worked with us in installing our hard unit here, and so we had two beds. The patients would go in there, and they were getting emission reduction chemotherapy for leukemia, which usually consisted of three courses, so it was about ten weeks’, twelve weeks’ duration that they’d stay in there.
Lesley Williams Brunet, CA:
So these were individual rooms or two people --
Gerald P. Bodey, Sr, MD :
Yeah. They were individual rooms.
Lesley Williams Brunet, CA:
That’s what I wanted to check.
Gerald P. Bodey, Sr, MD :
So everything that went in there was sterile, all the linens and everything including the food was specially prepared. We had a special kitchen, and much of the food was actually autoclaved and so on, so that was done. Then we had a special water supply system that was put in there. We did not have a shower or even a toilet. They used bedpans. They, of course, received antibiotic prophylaxis as well, an oral antibiotic. So we did a large amount of work with that unit doing environmental studies to make sure that we were not getting contamination on the floors and the water supply. Our initial water system that we put in didn’t work, and so we had to tear that out and—
Lesley Williams Brunet, CA:
Didn’t work at all, or—? Gerald P. Bodey, Sr, MD Well, what happened was that the sinks became contaminated from organisms that the patients were carrying. Pseudomonas was a very serious organism for these patients, and we couldn’t get rid of them. They got into the sink. The water was a steam purging system, so once a day, they’d purge the system with steam. But it didn’t really do very much in terms of keeping everything clean. So we had to rip that system out, and I came up with another system using a millipore filter, a terminal filter at the end of the water supply. We had stainless steel sinks that were situated in such a fashion that we could actually lift the sink out and send it off and auto-clave it, and so that way we were able to control or actually eliminate any kind of contamination. We also ran into the problem of the floor. Originally they had those tile squares that they put down, and after using the unit for about six months, we began to pick up pseudomonas on the floor. We couldn’t quite figure out where it was coming from, so we did some intensive searching and discovered what happened. Over a period of time, because we were keeping everything so clean and washing everything, we’d actually worn away the seal between some of the tiles. So water was getting down beneath some of the tiles, and it became contaminated. We had to rip out the whole floor, and this welded kind of material that they regularly use now was just being introduced around that time. Somebody found that for us, and so we put that in. That eliminated the problem. There were all kinds of little problems like that that we picked up over time as we were developing this program. But the program did make a big difference. Basically what we were doing initially was pretty much putting our younger patients in the unit, because at that time the infection rate was considerable for all ages of patients. So we selected the younger patients because they had generally a somewhat better prognosis, and that worked out fine because they didn’t get infections. Some of them did, but we greatly reduced the frequency of infection. Some of them sat in there, and they never got an infection the whole time they were being treated. They could kind of help take care of themselves and all that. Nowadays we have a lot of older patients going in there, and it’s a little more complicated because they can’t take care of themselves as well as the younger patients who now don’t need that kind of a unit.
Lesley Williams Brunet, CA:
You’re talking about older senior patients? Gerald P. Bodey, Sr, MD Now they put in patients who have a somewhat poor prognosis. They’re older in general than patients we were putting in at that time. I should point out, too, that anybody who went into the unit had to dress up with a sterile gown, cap and gloves, and the whole business. That became a bit of a problem for the nurses taking care of the patients going in and out all of the time. When the Lutheran Pavilion was designed, we were able to get a grant, a kind of construction grant from the National Cancer Institution. We designed a laminar airflow unit on the top floor, and if you notice there are windows that are not on any of the other wards. What we had designed was an exterior corridor that the family and the visitors would have access to directly, but they were not able to actually go into the room where the patient was. The patient’s unit then had one side with the visitor’s area, and then on the opposite side the nursing unit. It was a more sophisticated unit. We had eighteen laminar airflow beds, two preparation units, and then the two sides of the unit. We designed things similar to what we had originally. We had a more sophisticated water supply system, and we designed the units with one side having a plastic curtain down halfway with the sleeves in them so that the nurses didn’t have to go in the room all the time to do everything to take care of the patient. And of course, if they did go in, then they had to dress up, as did the doctors. So then the nursing station was maintained in a sort of semi-sterile fashion. That allowed the patient’s friends and relatives to come and visit with them. We had an amplification system. Well, actually it was a telephone system that they could speak back and forth. The medical staff and nurses and all that could carry the patient from the other side and get in each other’s way, but we were able to sort of control things better.
Lesley Williams Brunet, CA:
Because there was a certain amount of psychological stress. Gerald Bodey Yeah. Patients don’t enjoy particularly being confined to that extent, but there were very few patients that could not tolerate it. We did have a few. One of the really touching experiences to me was a patient who stayed in this unit a very long period of time. He just didn’t ever quite go into remission of his leukemia. He had a wife and two small children, and we finally were trying to figure out how we were going to bring this person out. Basically, we designed this so that patients would go in and go into remission and then come out. But he just never went into remission, and he wanted to stay until he went into remission. So finally he got a sort of partial remission where we decided we’d better bring him out now because we’d otherwise never be able to get him out of the unit. I can remember the day when the nurse pulled the zipper on the plastic tent to let him out, and I was reaching in there to touch him. It was quite an emotional experience for everybody. We learned from that experience we’re going to have a defined period of time. You’re getting your initial chemotherapy, and if you don’t respond to that, we’ll have to bring you out, other than just having an open-ended sort of thing. This unit here was closed down when they opened the Alcott Building. That was the first, and one of the very few units, that was ever created as part of the original design of the hospital. Most other places that have these laminar airflow units have constructed them within an existing structure. This is part of the original design of that building.
Lesley Williams Brunet, CA:
Let me just flip this over for— (End of Audio 1)
Recommended Citation
Bodey, Gerald P. MD and Brunet, Lesley W., "Chapter 03: Research into Leukemia: Life Islands and Laminar Air Flow Units" (2003). Interview Chapters. 978.
https://openworks.mdanderson.org/mchv_interviewchapters/978
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