In spite of using antibiotics, patients with acute leukemia undergoing cytotoxic therapy have a high incidence of infectious complications. In order to reduce the risk of acquiring infections from the environment, patient isolator has recently been developed. The design of a new portable clean bed with laminar air flow system, a collaborative effort by the Kinki University and Nihon Ikakikai Inc., is specifically for experimental leukemia chemotherapy, but is adaptable as a protective environment to other problems in medical management.
The wall of the head side consists of high efficiency particulate air (HEPA)-filter capable to removing 99.97% of all particles greater than 0.3 p. in diameter. The wall of the foot side consists of prefilter. The air passes through the bed from head- to foot side in a horizontal direction at a velocity of 0.5 m per second and the filtered air is recirculated via ceiling of the apparatus. The noise is 50 phone and the temperature is possible in moderate adjustment.
Bacteriological samples from the environment were taken by means of exposed settle-plates laid at the two sites (head- and foot side) of the ventilated clean bed and in open wards (single and six beds room). As culture medium was used Tryptosoy agar containing 6-8% sheep blood, and the plates of 86 mm in diameter were exposed for 9 hours.
Significant differences in the bacteriological results could be detected between the samples from the clean bed and from open wards. That is, comparing colony counts per one hour by sedimentation technique, 1.01 colonies at the head side, 1.19 at the foot side, 12.3 in single bed rooms and 25.05 in six beds rooms were observed respectively.
According to the classification of air cleanliness classes (standard of U. S. A., No.209), 100-1000 classes were obtained by the slit sampler method regardless of frequency of medical staff entering.
Identification of viable particles from the clean bed revealed staphylococcus epidermidis, coryn. ebacterium, γ-streptococcus and etc., being common skin flora.
Six patients with acute leukemia have been nursed in the clean bed. Cleansing procedures by chlorhexidine significantly reduced but not eliminated the organisms on the skin.
Despite of severe neutropenia during their stay in the clean bed, four of the six patients achieved remission of their leukemia without developed infection. One patient became feverish and died of endotoxic shock on the 14th day after the staff was forced to stop the fan of the apparatus because of his mental disorders. The other 5 patients were prevented from psychological disorders, such as sleeping disturbance, anxiety or irritation, by familiar staff-patient contact and by reforming of noise.

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An evaluation was made of Lysine-Iron-Cystine-Neutral red broth containing lactose and sucrose (LICNR/lac+suc), for the detection of Salmonella, Arizona and Edwardsiella.
Most cultures of hydrogen sulfide forming Salmonella, Arizona and Edwardsiella were easily and correctly detected after incubation at 37°C for 18 hr in this medium. The other members of the Enterobacteriaceae group were discriminated from Salmonella, Arizona and Edwardsiella.
The most hydrogen sulfide producing strains of Salmonella, Arizona and Edwardsiella changed neutral red in the medium from red to gray to yellow and formated a massive black precipitate. Also, Proteus mirabilis strains changed to gray to yellow and formated a black precipitate. Differentiation of Salmonella and P. mirabilis was accomplished which the 0.1 ml of Bromthymol blue indicator were added in to the each tube and recording the color change. Salmonella gave an alkaline reaction, but P. mirabilis remained as it.
The non-hydrogen sulfide producing Salmonella, Arizona strains changed to yellow, but not formated a black precipitate. Hafnia alvei and Klebsiella pneumoniae also usually changed the medium from red to yellow and not developed a black precipitate. And then adding BTB indicator, non-hydrogen sulfide forming Salmonella, Arizona, H. alvei and K. pneumoniae changed from yellow to blue or bluish green, indicating an alkaline reaction. If this medium was incubated at 43°C, the growth of H. alvei and K. pneumoniae was inhibited, and remained as its color, i. e. red.
On the other hand, the growth of Salmonella strains were not influenced by this temperature, these reaction were observed, i. e. yellow color of the medium, non-blacking, blue color of BTB indicator.
By use of this medium, Salmonella, Arizona and Edwardsiella were differentiated from other members of Enterobacteriaceae. The LICNR/lac+suc broth is recommended as a medium for use in the detection of Salmonella, Arizona and Edwardsiella in the routine examinations, especially for use hydrogen sulfide forming strains.

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