Chapter: 04 Building MD Anderson’s Laminar Air-Flow Hospital Units

Authors

Gerald P. Bodey MD, The University of Texas MD Anderson Cancer Center
Tacey A. Rosolowski PhD, The University of Texas MD Anderson Cancer Center

Files

Description

Dr. Bodey begins this segment by providing some background on the first laminar airflow unit developed by J.M. Matthews. The early units were called “life islands” and Dr. Bodey describes the protective environment they provided against organisms. MD Anderson had some units in 1966, and Dr. Bodey recalls one patient who remained in a unit for about a year.

Dr. Bodey describes some of the challenges of setting up the units to be completely sterile environments. He then describes in more detail how the laminar flow of air originated on one wall of the unit, with the filtered air all flowing in one direction. The patient would be located as close as possible to the source of the filtered air.

Dr. Bodey then recalls that he had difficulty convincing Dr. R. Lee Clark to fund laminar air-flow units, as they were expensive to operate and took up three beds for every two, resulting in a loss of income for the institution. Dr. Clark eventually agreed to fund two units. When the Lutheran Pavilion was constructed, funds were allocated to build twenty units on the top floor. Dr. Bodey explains that the staff offices were in the center of the floor plan, with the laminar air-floor units arranged an a circle around them. The outermost ring was a corridor that family members could use to visit with patients by telephone: the walls of the patient units along the corridor were glass.

Dr. Bodey recalls that the NCI also gave grants to support the units. He recalls working with an air conditioning company in Albuquerque, New Mexico: they created the air flow system. Dr. Bodey notes that the laminar air-flow units were the last elements of the Lutheran Pavilion to be built. He describes some of the investigations that were run on the units to identify and quantify the organisms presents in the units: studies of organisms on the patients’ skin; studies of how sterile the environments remained. He concludes this segment by noting that, given their cost to build and operate, the benefits of the units were not dramatic enough to warrant continued operation. The institution ceased using them after 1995 and now semi-protective units are used in some circumstances.

[The recorder is next paused for about 5 minutes]

Identifier

BodeyGP_01_20130619_C04

Publication Date

6-19-2013

City

Houston, Texas

Interview Session

Gerald P. Bodey Sr., MD, Oral History Interview, June 19, 2013

Topics Covered

The Interview Subject's Story - The ResearcherOverview Definitions, Explanations, Translations The Researcher The Clinician Industry Partnerships Patients Patients, Treatment, Survivors Cancer and Disease

Transcript

Tacey Ann Rosolowski, PhD:

I’d like to talk about something related to this work on infections, which was your development of the Protected Environment Program, particularly the laminar airflow system, which was put in place in ’77.

Gerald P. Bodey Sr., MD:

The year that I was leaving the National Cancer Institute, there was a man by the name of Matthews—T.M. Matthews—who developed the protective environment, which was a bed with a plastic tent around it. [See image next page.] Then you had some chambers on the bottom where you could put things in and take things out and sleeves on the side. And you had a filtered air system so this would expand, and it had a bed in there. The patient could get up off the side of the bed, but he wasn’t going to be able to go anywhere. So it was protective enough. They were protected against the environment and the air and everything else, but it limited the patient’s ability to do anything.

Tacey Ann Rosolowski, PhD:

Now what was the range of things that the protected environment was designed to keep out? It may seem obvious, but—

Gerald P. Bodey Sr., MD:

Anything—any organism that is floating around in the air or that could be carried in by the doctor or nurse examining the patient. Anything. Even the food was specially prepared.

Tacey Ann Rosolowski, PhD:

So you were primarily concerned with organisms, not with dust or particles or anything like that?

Gerald P. Bodey Sr., MD:

There had been filtered air before but the patient could be contaminated from some other source. The objective was to make it as germ-free an environment as possible. This was the first type of unit. It was called a Life Island. They just got those in around the time I was leaving the National Cancer Institute to go to Seattle. When I came down here, they had—I think they already had some or they were getting some. I became responsible for them. We had two of these Life Island units. It was difficult for the patients. Suddenly they couldn’t go anywhere. There was plastic so they could see what was going on. Anything they needed, or if they wanted to go to the bathroom or something, they had to have somebody come to help them. It was very inconvenient, but it did reduce the risk of infection. We had one patient—a remarkable man—he was American and his wife was British. They had two children. He stayed in a Life Island. He didn’t want to come out until he went into remission. I can’t tell you any longer how long it was, but I think it was close to a year that he stayed in. Then finally his bone marrow looked somewhat better, and I said, “We better take him out of here now,” because otherwise he may never get out of here. Unfortunately, we got him out and he only lasted about a couple—no more than a week or so. He got a fungal infection or something, which he may have actually had before he came out. At any rate, he didn’t last very long. What I will never forget is his wife and his two little boys came into the room. Then they unzipped the side of the tent, so he could come out, and these kids were just clutching him, there to touch their father. I just felt really so badly, because he had stayed in there for such a long time, then he comes out and in a matter of a week I’m pretty sure he had developed histoplasmosis as his cause of death. He only lasted something like less than a week outside.

Tacey Ann Rosolowski, PhD:

So he was still extremely fragile because of the suppressed immune system?

Gerald P. Bodey Sr., MD:

It was not the most ideal situation, but it was as close as he was coming to getting in remission He did have some good white cells and all that, and we just felt like, “We can’t keep this poor man in until he dies. His family needs to have some chance to be with him. He does have enough white cells. He should be able to do all right, and hopefully he’ll continue to do better.” Unfortunately, he had this existing infection that hadn’t manifested itself, and it was not very long until he died. Then somebody at the National Cancer Center—I went down there for a meeting—asked me if I would be interested in laminar air filters. Then they described what they were and so on. I said, “Yes, we certainly would.” We had to convince Dr. [R. Lee] Clark and his associates that it was worth tying up two rooms of the hospital to put these units in. But we were able to install two laminar air filter units with a corridor in between.

Tacey Ann Rosolowski, PhD:

Can you describe what the air flow is in the laminar airflow? And why is it important?

Gerald P. Bodey Sr., MD:

Instead of just coming in and down, it comes in laminar distribution. So one whole wall of the room was filled with these screens, which have little holes in them, and the air came through there in a laminar pattern across the room. Of course, by the time it got down to the end it wasn’t so laminar anymore.

Tacey Ann Rosolowski, PhD:

Why was it designed that way?

Gerald P. Bodey Sr., MD:

It would prevent the causation of the air somewhere in a corner getting some kind of infection in it or something like that, so it kept the air pure as it came through the room.

Tacey Ann Rosolowski, PhD:

So it kept it circulating in a really systematic way?

Gerald P. Bodey Sr., MD:

Yes. It recirculated it. It returned through a vent in the ceiling, and so it was just constantly filtered. It was possible to adjust the number of air exchanges per hour. Now, of course, there were other things we had to do, too. We had to design a water supply system that was filtered. And that wasn’t very picturesque, but it did work.

Tacey Ann Rosolowski, PhD:

Why do you say it wasn’t picturesque?

Gerald P. Bodey Sr., MD:

We had this great big container unit that held the water supply. Then, the water would come out from the water supply system and go through this filtering system. So the water was filtered. Then it would come out and go into this drain. Now, the drain was stainless steel, and we took it out at regular intervals and cleaned it. It was quite an operation. But the patient then was able—if he was able—to get up out of bed, he could go and brush his teeth and that sort of thing over this stainless steel sink. And we had this sterile water going through this filtering system. I’ll tell you one thing funny. The water system, of course, came through a pipe from the hospital system. We would change the filtering system once a week to sterilize it. One day it was due to be changed, and I was busy, so I asked one of my associates to go down and to change the sterilizing system. So he goes down there, and he disconnects the sterilizing system but forgets to turn off the water. So water’s shooting out, and he didn’t know how to turn it off. It ended up actually going through the floor into the room underneath. He never forgave me for that.

Tacey Ann Rosolowski, PhD:

He didn’t forgive you?

Gerald P. Bodey Sr., MD:

I’ll tell you, there he was when I came down—they called me. He’s standing there trying to hold this water in and getting soaking wet and the water is all over the place. What a mess.

Tacey Ann Rosolowski, PhD:

I’m curious, with the design with the flow of air through the space the way it was, did you plan tasks in specific places within?

Gerald P. Bodey Sr., MD:

Plan what?

Tacey Ann Rosolowski, PhD:

Well, I’m wondering like if somebody had to come in to do something, did you have them do it close to the origin of the air source and sweep it away?

Gerald P. Bodey Sr., MD:

The way the system was designed—and you can get a copy, I’m sure, from the archives of one of the papers that has a picture. Here’s the wall, which is the flow of the air filtration system. So it’s a wall with holes in it, and the air is coming out. Then the bed is right up against the wall there.

Tacey Ann Rosolowski, PhD:

Now, why did you place the bed there next to the holes where the air came out?

Gerald P. Bodey Sr., MD:

There was space so it didn’t block the air, but it was close enough so that the air wouldn’t get contaminated in any way. Now, all the bedding and all that was sterilized. There was a space at the door into the room so that we could come in and stand down on a space without having to go through a lot of rigmarole and put a mask on.

Tacey Ann Rosolowski, PhD:

Basically, you were standing downwind?

Gerald P. Bodey Sr., MD:

Right, exactly.

Tacey Ann Rosolowski, PhD:

So the air was passing over you and your air wasn’t brushing onto the patient. I see.

Gerald P. Bodey Sr., MD:

Yeah, and then the sink and all that stuff was down in that area, which we stayed away from.

Tacey Ann Rosolowski, PhD:

So basically, the patient was always getting fresh filtered air passing over them?

Gerald P. Bodey Sr., MD:

That’s right, yes. Now, along this one wall were closets, shelves, and all that. They could open them from either side, so they could take sterile items and put them in there carefully without contaminating them, and the patient or a nurse who was in a sterile gown and all that, from the other side, could come and get them and take them to the patient. And then the patient had a little stand there by his bed and a light and all that. It was about as good as you could get and have that kind of a restricted environment. So we had two of those rooms initially, with this corridor in between where we stored things. Then they decided they were going to build the new Lutheran Pavilion at MD Anderson.

Tacey Ann Rosolowski, PhD:

Well, I guess, before you say that—you said you had to convince R. Lee Clark to fund it?

Gerald P. Bodey Sr., MD:

I did, because we ended up taking up three beds for two, so he wasn’t entirely enthusiastic about this. They had several meetings, which I attended, to discuss whether they were going to go ahead and do this or not. And finally, Dr. Clark said, “Okay, well, we’re going to go ahead and do it.”

Tacey Ann Rosolowski, PhD:

What convinced him?

Gerald P. Bodey Sr., MD:

I don’t know. I’d like to say I did. I’m not sure, but he finally did agree to do it.

Tacey Ann Rosolowski, PhD:

Now what were the arguments that you used at the time?

Gerald P. Bodey Sr., MD:

Oh, I don’t remember. Well, I mean the discussion was all on the potential benefits to the patients and that sort of thing. But we did recognize, of course, that they were losing one bed of income from having that there. There was a lot of conflict and several discussions. But then Dr. Clark finally decided to do it. He said, “Okay, gentleman, that’s it. We’re gonna do it.” I was getting kind of discouraged because I thought the direction seemed to be going the other way. So we had those two units. When the Lutheran Pavilion was put up, they decided that the top floor would be a laminar air filtered floor, the whole thing. There were twenty beds in there, two sides. It had a kitchen in there and everything. Now, there was—the way it was designed, there was a corridor on the outside, so that the patient’s relatives could come in and they could talk to the patient and all that, yet they had a barrier between them and the patient.

Tacey Ann Rosolowski, PhD:

So there was like a core in the center with all of the laminar air filter rooms?

Gerald P. Bodey Sr., MD:

No, the core was for the personnel who were working.

Tacey Ann Rosolowski, PhD:

Oh, okay, and then a ring around them?

Gerald P. Bodey Sr., MD:

Well then there were the rooms that went around it. Then there was a— (End of Audio 1 Session 1)

Gerald P. Bodey Sr., MD:

—then there was a corridor on the outside.

Tacey Ann Rosolowski, PhD:

Interesting.

Gerald P. Bodey Sr., MD:

So there was a special elevator that came up for the relatives to come up and then go right up to the outside of it.

Tacey Ann Rosolowski, PhD:

Now, let me ask you, on what basis was the go ahead given to put those twenty units in the top floor of the Lutheran Pavilion. I mean, did you, in the meantime, demonstrate that—?

Gerald P. Bodey Sr., MD:

We had some fairly positive results. I would think that the National Cancer Institute was interested as well. We did get grants from them. I’m not sure what else might have played a role in it. I know it was expensive to operate, and the hospital wasn’t making money on it.

Tacey Ann Rosolowski, PhD:

Right. Well, I’m just curious, if R. Lee Clark was so reluctant with these two original units, there must have been something convincing to say, “Yeah, let’s have the whole top floor of the Lutheran Pavilion be devoted to this.”

Gerald P. Bodey Sr., MD:

I can’t answer that. I don’t recall. I know there was a lot of discussion. There wasn’t so much discussion then as before, part of the reason being the NCI was going to be putting a lot of money into this development. In addition to that, we worked with Envisco, which was an air conditioning company in Albuquerque, New Mexico. But I used to go out to Envisco, and the chairman of their company was very interested our project, and some of the other people that worked for them. Their company had worked with the federal government in providing the facility for developing the atom bomb. If my memory serves me correctly, the scientist who was the head of the development of the atom bomb was out there. I think that they had a laminar flow facility there where they were building the atom bomb, if my memory serves me correctly.

Tacey Ann Rosolowski, PhD:

So the air conditioning company was actually involved in creating the filtration system for the air? That’s what they contributed to the project?

Gerald P. Bodey Sr., MD:

Yeah, they worked with us. I would go out there on a regular basis. They were greatly involved in the design of our unit. One of the things that I will never forget is that when I went out there, in those days the only airline was the Texas Treetops—the Trans-Texas. They always stopped at Midland-Odessa out in west Texas—where George Bush grew up. Anyway, they always stopped there, then from there on to Albuquerque. I can always remember as we flew over to come into the airport there, you look out across the land below us and see many properties divided into squares. There was a little driveway around each of them, but no homes. I don’t know what they were growing there. I looked down, and I thought, “Why on Earth am I living in Texas?” I just felt so sorry for those people that had to live down there. George Bush grew up there. Well, I went out there, not often, maybe two or three times a year. I’d come in and share some ideas about how we could improve something and that sort of thing.

Tacey Ann Rosolowski, PhD:

How long did it take to plan that?

Gerald P. Bodey Sr., MD:

It didn’t take terribly long to develop a plan. It took a while to get it built because it was the last thing that was built in the Lutheran Pavilion. That was the twelfth floor.

Tacey Ann Rosolowski, PhD:

Now that was the—as I understand it—the first time that laminar airflow units were actually planned into a building—

Gerald P. Bodey Sr., MD:

That’s right. Yes, it was.

Tacey Ann Rosolowski, PhD:

—and built into a building.

Gerald P. Bodey Sr., MD:

That’s correct. Yes, it was. It was really a major step forward. I felt badly when they decided to shut it down, but they had been threatening to do it for some time because it was very expensive, and the benefits were not exceedingly dramatic. The incidence of infections in those patients was greatly reduced, but they were not completely eliminated.

Tacey Ann Rosolowski, PhD:

Did that surprise you?

Gerald P. Bodey Sr., MD:

What?

Tacey Ann Rosolowski, PhD:

That you didn’t get more striking results?

Gerald P. Bodey Sr., MD:

No, because people carry organisms in their gastrointestinal tract, and you do the best you can with the antibiotic regimens you use and so on, but it’s not perfect.

Tacey Ann Rosolowski, PhD:

How long were the laminar airflow units operational?

Gerald P. Bodey Sr., MD:

I think we started in 1977.

Tacey Ann Rosolowski, PhD:

Yeah, that’s what I have, 1977.

Gerald P. Bodey Sr., MD:

And they put the additional building that’s there now—it happened after I retired. It was around that time.

Tacey Ann Rosolowski, PhD:

So it operated almost twenty years?

Gerald P. Bodey Sr., MD:

They still use that. They have a semi-unit now, but it’s not sophisticated. This, I think, has just filtered air or something along those lines.

Tacey Ann Rosolowski, PhD:

Now, were there studies that you ran with the—?

Gerald P. Bodey Sr., MD:

Oh, yeah.

Tacey Ann Rosolowski, PhD:

So what kinds of trials did you run with the patients in the units?

Gerald P. Bodey Sr., MD:

The same sort of thing—chemotherapy results and infectious disease results and so on. We did all—well, we did a lot of other things too, environmental kinds of things. We did studies on the air, studies on the floor.

Tacey Ann Rosolowski, PhD:

Why? And what kinds of studies did you run?

Gerald P. Bodey Sr., MD:

These kinds of studies were bacterial. We did studies on the skin of the patient’s, how much contamination there was, and what different regimens did in eradicating organisms on the skin, the frequency of infections, and all that sort of thing. I wrote, I guess, somewhere around eight papers. Again, they’d be in those archives if they’re still in existence. I don’t have any of that material anymore.

Tacey Ann Rosolowski, PhD:

And when you studied things in the floor—the environmental things—you were interested in like how long they’d stay sterile?

Gerald P. Bodey Sr., MD:

We actually would—we painted squares on the floor, then we’d go and wipe over them with moist cotton and then put it into a container and grow it and see what grew in there and see how sterile the environment actually was. We did water samples. The water was filtered with these same kind of filters I mentioned earlier, to eliminate any organisms. We were interested in whether doing all these things made a difference in terms of the patients’ outcomes. And we studied the skin flora. If my memory serves me correctly, and I’m sure it does, we divided the body up into twelve parts, and then we’d send a technologist in with cotton balls—then she would dip it in a little sterile water, rub it over the patient, and then bring this material in for culture. So we would be able, actually, not only to identify the organisms but to quantitate the amount of contamination that was present. We did a lot of studies of that nature. I’m not sure how beneficial they were in the end. The way the room was designed was the outer side included a window in it, and that was the side that the relatives came in. There was a telephone connection so you could talk back and forth. On the inner side, there was a plastic curtain with armlets in it so that you could do all the procedures and all that you wanted to do on the patient. There was a door into the room, but we didn’t go into that regularly. The patient had a sink there and had a water supply that had been sterilized. It was a fairly well-designed unit. Then of course the one wall was all the filtered air system. The basic problem was those rooms were expensive to maintain, and ultimately, those in the administration that were concerned about funding had other priorities than this. They finally won the battle, and the unit was shut down.

Tacey Ann Rosolowski, PhD:

Was your feeling that it made a difference? Were you sorry the administration shut it down?

Gerald P. Bodey Sr., MD:

It made a difference, but I’m not sure that it was worth the expense and effort and all, because we had a separate kitchen with a dietician. We had to have special nurses. I mean, it was a very expensive operation. My conclusion basically, would be that, yes, it did have some benefit, but the benefit wasn’t worth the expense and the difficulties associated with it.

Tacey Ann Rosolowski, PhD:

Now what would be done since those units are not available?

Gerald P. Bodey Sr., MD:

I really can’t tell you that because I retired right around the time they started doing that, and I haven’t been involved at all since then. (End of Audio 2 Session 1)

Recommended Citation

Bodey, Gerald P. MD and Rosolowski, Tacey A. PhD, "Chapter: 04 Building MD Anderson’s Laminar Air-Flow Hospital Units" (2013). Interview Chapters. 988.
https://openworks.mdanderson.org/mchv_interviewchapters/988

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