Obtaining the Sword
The sword can be seen in a painting, within the office containing the entrance to the basement. To pick it up, press Axe.while looking at the painting. The sword will permanently replace the
The sword works identically to the axe; with the exception that it kills The Virus, Monster 1, Monster 2, Monster 3 (temporarily), Monster 4, Monster 5, and Scare Chair's shadow. Successfully killing all monsters will trigger an alternate ending in Karamari Hospital.
- The Virus can only be killed once the player turns the power off.
- Monster 3 is the only monster that can re-appear after being killed.
- When the silhouette appears on the Scare Chair, the player can destroy it with the sword and sit down again.
- However, if the player sits again, they will be trapped and die after a few seconds.
- When the player kills Monster 2, they will be immediately teleported out of its trap room.
- Monster 6 is the only enemy which cannot be killed with the sword.
- The Sword is not available in Endless Mode in the original game, but was intended to. This was changed in the HD Renovation. 
It now has a 3D model and a black aura can be seen surrounding the sword when it is held. It creates a violet-pink glow when swung.
- The sword requires the Use button (left mouse by default) to be held for a brief period to "prime" the sword before swinging it, meaning it cannot be swung as fast.
- Priming the sword and swinging it both deplete about 1/10 of the stamina bar, meaning a full sword swipe now depletes twice as much stamina as before.
- The sword can no longer be used if the player does not have enough stamina, and an acoustic guitar sound will instead play if they attempt to use it.
- The player will not be teleported out of Monster 2's room.
- Monster 3 no longer reappears in a different room in Karamari Hospital when killed with the sword.
Additionally, if Karamari Hospital is completed, the sword can be found in Endless Mode, where it can be seen lying on a surgical instrument table outside the mansion's entrance. In Endless mode, the sword and axe affect the same enemies, but Monster 2 cannot be harmed/killed in this mode.