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MRSA

Answer

I have been asked to reply.The information requested falls within the responsibility of the National Statistician, who has been asked to reply.Letter from Colin Mowl, dated 23 July 2007:"The National Statistician has been asked to reply to your questions asking why MRSA is not a recognised cause of death and whether it will be policy to adopt the recommendations of the (a) World Health Organisation and (b) Office of National Statistics and allow MRSA to be cited on a death certificate as a contributory factor. I am replying in her absence. (150539, 150538)""Diseases caused by infection with Meticillin Resistant Staphylococcus Aureus bacteria (eg MRSA septicaemia, MRSA pneumonia, MRSA wound infection etc) are recognised as causes of death and can be cited on death certificates. The Office for National Statistics publishes annual statistics on deaths certified as due to or contributed to by MRSA.""The World Health Organisation (WHO) makes recommendations, in the International Classification of Diseases, currently in its tenth revision (ICD-10), on certification of cause of death by doctors, coding and classification of diseases, and selection of a single cause for each death for statistical purposes. The General Register Office and ONS follow ICD-10 recommendations and go further, as explained below.""Doctors have a statutory duty, under the Births and Deaths Registration Act 1953, to certify the cause of death to the best of their knowledge and belief. GRO produces books of Medical Certificates of Cause of Death (MCCDs), in the format recommended by WHO, and supplies these to doctors through local registrars of births and deaths. The books include notes to doctors, based on ICD-10, on how to complete the MCCD. These ask the doctor to describe the sequence of illnesses or events that led directly to death in part I of the MCCD, ending on the last used line with the underlying cause of death. The underlying cause is defined by WHO as the disease or (external cause of) injury that initiated the morbid train of events leading directly to death. Certifiers are also asked to write in part II of the certificate any other conditions which contributed to the death but were not part of the direct sequence. WHO makes clear that the certifying doctor must use his/her clinical judgement to decide which of the conditions present at or before death contributed to the death and so should be included on the certificate.""In addition to the notes in the front of every book of MCCDs, the ONS Death Certification Advisory Group (DCAG) published updated guidance to certifiers in ACP News and on the GRO website (www.gro.gov.uk/medcert/) in June 2005. This guidance, which is also supplied to doctors with every new book of MCCDs, includes specific advice about certifying deaths involving health care associated infections (HCAI). The Department of health’s Chief Medical Officer, Sir Liam Donaldson, in his ‘CMO Update’ no 42 of July 2005, which is sent to all registered doctors, drew attention to the DCAG guidance in a short article entitled ‘Certifying deaths involving MRSA’ http://www.dh.gov.uk/en/PublicationsAndStatistics/LettersAndCirculars/CMOUpdate/DH__4115663). These publications, from ONS/GRO and the Department of Health, make absolutely clear that doctors should include MRSA and other HCAI on the death certificate in the appropriate place if they believe that the infection was part of the direct causal sequence or contributed to the death.""WHO recommends that the underlying cause of death is tabulated for routine mortality statistics because preventing it would prevent not just the death, but the whole period of illness leading up to death and so result in the greatest health gain. MRSA infection is often associated with health care, and so it will not usually be the underlying cause of death, which may be the disease or injury necessitating the care during which the MRSA infection was acquired. Because of the public, policy, professional and media interest in the subject of MRSA infection, ONS provides more than just routine underlying cause statistics. Using ICD-10 codes and the full text from MCCDs, ONS publishes annual figures on the number of deaths in which MRSA was mentioned anywhere on the death certificate, in addition to those where it was selected as the underlying cause of death. Figures for 2001 to 2005 were published in Health Statistics Quarterly no 33, which is available in the House of Commons library, in February 2007. Statistics based on death certificates which cited MRSA have also been quoted in answer to a number of previous Parliamentary questions and published in Hansard. In 2005 there were 1,629 death certificates that cited MRSA in England and Wales and in 29% of these (467 deaths) MRSA was the underlying cause of death."

Secondary information

Type

Written question

Reference

150539; 463 c819-21W

Session

2006-07

Subjects

MRSA

Link

View this Written question on www.publications.parliament.uk