"I knew it was low, but I didn't think the numbers were that low," said Dr. Dale Carrison, head of the emergency department at University Medical Center. "The sad thing is that if everybody in the country were immunized, the problem with seasonal flu would basically go away. And people in health care know that."

That knowledge, according to Dan Davidson, a vice president of Sunrise Hospital and Medical Center, helped lead to a decision by the hospital's owners, Nashville-based Healthcare Corporation of America, to require hospital employees to be vaccinated or to wear surgical masks in patient areas if they are not vaccinated.

"We want to protect our patients," said Davidson, adding that the policy is in effect at all 160 HCA hospitals in the United States.

Davidson said the policy does not include vaccinations for the H1N1 flu, also known as swine flu, because of a shortage of the vaccine.

New York, which had been the only state in the union to require health care workers to receive both seasonal flu and H1N1 vaccinations, backed off the policy a week ago because of the H1N1 vaccine shortage.

The decision by HCA is one that until recently only a few U.S. hospitals had made, with Virginia Mason Hospital in Seattle being the first five years ago. More than 99 percent of hospital employees there now get vaccinated yearly.

"It's something we did for the safety of our patients," said Alisha Mark, a spokeswoman for the hospital. "We believe it has worked."

Just as the policy at Virginia Mason provoked a lawsuit, so has the policy at Sunrise and Southern Hills hospitals.

Last week, the union representing local hospital nurses and other employees, Service Employees International Union Local 1107, sued HCA in U.S. District Court.

"We don't think the vaccinations should be mandatory, and we don't think there should be discipline involved if an employee decides against a shot," said Fredo Serrano, a registered nurse at Sunrise and union representative. "But we believe health care employees should get vaccinated both for the good of patients and employees."

There's a difference between believing something is right and forcing staff to undergo an injection, he said.

In the case of Virginia Mason hospital, the court ruled that unionized employees did not have to be vaccinated, but they could be told to wear masks in certain areas of the hospital, Mark said. If that policy was not followed, discipline could result, as it could at Sunrise and Southern Hills.

"Almost everybody decided to go ahead and get a shot," Mark said.

Serrano said the Sunrise policy would invoke a progressive discipline system that could result in termination.

No other hospital system in Clark County has such a policy.

Officials with the Valley Health System, UMC, St. Rose Domican Hospitals and North Vista Hospital all say they strongly encourage personnel to get vaccinated but do not make it mandatory.

"I think it's really hard to make things mandatory," said Audrianne Schneider, a spokeswoman for North Vista Hospital.

If staff members choose not to be vaccinated, Schneider said, they need to take other precautions to protect the safety of employees and patients, such as hand-washing, good hygiene and recognizing their own flu symptoms.

Tracy Puckett, director of infection control and clinical care at UMC, said hospital personnel there must always "follow infection control practices regarding anything that is contagious." That means if they are in close contact with an H1N1 patient for a procedure, they might wear gowns, surgical masks and gloves.

MountainView Hospital, which also is HCA-owned, also follows the policy in effect at Sunrise and Southern Hills; the property, which is not unionized, is not mentioned in the lawsuit.

Davidson said it appears that the policy at Sunrise, first announced in August to employees, has been working.

"Over 90 percent of the Sunrise employees have been vaccinated," he said. Although that percentage is higher than in the past, he did not know how much higher.

A certified nurse assistant at Sunrise who asked not to be identified Monday said she and her co-workers felt pressure to get vaccinated.

She didn't want to take a flu shot because of a bad reaction several years ago, but did so because the alternative was a "hassle," she said.

"You have to wear that uncomfortable mask all day, and if you get caught without it, you get into trouble," she said, adding that her peers don't believe the mask prevents the spread of the flu.

"I think it's for looks," she said. "I don't think it does much of anything."

In the hallways at Sunrise, almost all of the employees who dealt with patients had the orange sticker on their badges that signify they had been vaccinated.

One of the employees wearing a mask did not wish to comment, and another said she wore the mask because she had a cold.

"I've had my shot," she said.

Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, tried unsuccessfully for years to make it mandatory for health care workers to be vaccinated against the flu, a position long taken by the National Foundation for Infectious Diseases.

"It's the best way to protect patients and to protect the families of health care workers," said Len Novick, executive director of the foundation.

More than 36,000 people die each year of the seasonal flu, according to the CDC.

The CDC has reported that flu vaccine has been shown to prevent influenza in about 70 percent to 90 percent of healthy persons younger than 65.

The federal health agency has also reported that vaccinating health care workers "has been associated with reduced work absenteeism and with fewer deaths among nursing home patients and elderly hospitalized patients."

According to a 2009 CDC report on "Influenza Vaccination Coverage Levels," health care workers "who decline vaccination frequently express doubts about the risk for influenza and the need for vaccination, are concerned about vaccine effectiveness and side effects, and dislike injections."

Serrano said health care workers don't get flu shots for the same reasons as everyone else.

"We're all human, just like everybody else," said Serrano, who has gotten his seasonal flu shot but not the H1N1 vaccination.

"It is true," UMC's Carrison added, "that a health care worker sees what happens when there is a bad side effect to a vaccination. That stays with them."

Contact reporter Paul Harasim at pharasim@ reviewjournal.com or 702-387-2908. Contact reporter Mike Blasky at mblasky@reviewjournal.com or 702-383-0283.