Infection Control and Racial/Ethnic Disparities in Influenza and Pneumococcal Vaccination in Nursing Homes

Adults over the age of 65 are at increased risk for influenza and pneumococcal infections; particularly those residing in nursing homes (NHs). Despite the efficacy of influenza and pneumococcal vaccinations, vaccination receipt rates among NH residents remain well below federal recommendations and racial/ethnic disparities exist. Minority NH residents (non-Hispanic Blacks and Hispanics) are less likely to be offered either vaccination and are more likely to refuse them compared to their non-minority counterparts (non-Hispanic Whites). In the past decade, requirements have been implemented to increase vaccination coverage in NHs, but there is little documentation regarding current racial/ethnic disparities in vaccination receipt. Furthermore, activities important to resident care delivery and the prevention of care deficiencies such as infections are primarily dependent on the care provided by certified nursing assistants (CNAs). For these reasons, current research examining racial/ethnic disparities in vaccination receipt in NHs is needed and more attention directed towards CNAs is necessary to improve resident care delivery and outcomes related to infection prevention and control. This dissertation furthers our understanding of racial/ethnic disparities in influenza and pneumococcal vaccination coverage among minority NH residents and the role racial/ethnic diverse CNAs play in infection prevention and control. Chapter One introduces the problem of health disparities in nursing homes (NHs) related to differences in preventative vaccination receipt by racial/ethnic status and the role CNAs play in infection prevention and control. Chapter Two, an integrative literature review on racial/ethnic disparities in NHs, describes racial/ethnic disparities occurring in the NH setting in the context of infection prevention and control and influenza and pneumococcal vaccination receipt along with contributing factors and existing strategies related to policy that have been implemented to address poor care quality. In Chapter Three, facility-level factors related to the CNA’s role and the barriers and facilitators they experience that contribute to infection prevention and control are discussed. In Chapter Four, a systematic review of previous research on racial/ethnic disparities related to influenza and pneumococcal vaccination in NHs, individual, community, and facility-level factors that determine these disparities in influenza and pneumococcal vaccination receipt, along with associated strategies and practices are discussed. In Chapter Five, a national quantitative analysis of vaccination receipt practices (vaccination administered) and reasons for vaccination non-receipt (i.e., not offered versus refused) are presented. The results of this dissertation will inform clinicians and NH administrators as well as future policy and public health interventions and provide evidence needed to improve racial/ethnic minority health and eliminate health disparities.