K Number
K033222
Device Name
OLYMPUS STERILIZATION TRAYS
Date Cleared
2004-08-02

(304 days)

Product Code
Regulation Number
880.6850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Olympus sterilization trays are intended to be used to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a health care provider. It is intended to allow steam sterilization of the enclosed medical device. The qualification for sterilizing endoscopic instruments were validated with a process challenge device (PCD) by a GLP approved laboratory. The PCD has a diameter of 2 mm and a length of 1500 mm. The Olympus sterilization trays are to be sterilized in the following cycle: Prevacuum Steam: 132°C - 134°C - 5 minutes minimum. Drying Time: 10 – 20 minutes as needed.
Device Description
The Sterilization trays, which are the subject of this premarket notification, are as follows: Item no. | Outer dimensions WxHxD[mm] | Detailed product description ---|---|--- A5938* | 595 x 61 x 295 | Instrument tray, with lid, for video telescope A5951* | 478 x 41 x 224 | Insert tray, for 2.7 and 4.0 mm TruView arthroscopes A5952* | 478 x 41 x 224 | Insert tray, for Diver-Line hand instruments A5961* | 665 x 52 x 204 | Insert tray, for ureteroscopes, with lid A5975* | 532 x 63 x 128 | Instrument tray, small, with lid A5976* | 478 x 68 x 224 | Insert tray, for urology A5977* | 478 x 68 x 224 | Insert tray, for 4 TroQ trocars A5984* | Set: A5994 and WA05974 | Instrument tray, for camera head and adapter A5992* | 478 x 54 x 224 | Instrument tray, for A3336A, A2027A and A5226A A5994* | 478 x 68 x 224 | Insert tray, for camera head and adapter A05951A* | 478 x 41 x 224 | Insert tray, for TrueView II and mini TrueView telescopes A05952A* | 665 x 65 x 204 | Instrument tray, for SonoSurg instruments, with lid A05961A* | 405 x 95 x 200 | Instrument tray, for compact cystoscope and compact hysteroscope, with lid WA05970A | 537 x 139 x 268 | Instrument tray, with lid and silicone mat WA05971A | 482 x 60 x 224 | Insert tray, for the upper part of WA05970A, with silicone mat WA05972A | 480 x 47 x 224 | Insert tray, for 5 HiQ shafts and jaw inserts WA05973A | 460 x 39 x 207 | Insert tray, for the bottom of WA05970A, with silicone mat WA05974A | 488 x 31 x 235 | Lid, for insert trays WA05980A | 438 x 176 | Spare mat, nubbly, silicone, for WA05970A and WA05971A WA05981A | 400 x 175 | Spare mat, nubbly, silicone, for WA05973A WA05990A | 446 x 88 x 49 | Instrument tray, for two telescopes, with lid WA05994A* | 478 x 68 x 224 | Insert tray, for camera head and adapter WA05995A* | 478 x 68 x 224 | Insert tray, pediatric urology WA05980A* | 595 x 61 x 295 | Instrument tray, for video telescope The Olympus sterilization trays consist of perforated bottoms with or without perforated lids. The material of the bottom is thermoplastic, the material of the lid is thermoplastic with handles and locking tabs made from medical grade stainless steel. The silicone mats for fixture of the instruments are perforated for aeration. The stripes are designed for minimal contact area with instruments and secure fixing. Olympus sterilization trays will be sold non-sterile and can be reused after proper cleaning and sterilization.
More Information

Not Found

No
The device description and intended use are solely focused on physical sterilization trays and their materials, with no mention of software, algorithms, or data processing.

No.
The document states that the Olympus sterilization trays are intended to be used to enclose Olympus medical devices for sterilization and are not themselves therapeutic devices.

No

The device description clearly states that the Olympus sterilization trays are intended "to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a healthcare provider." These trays are for holding medical devices during sterilization, not for diagnosing any medical condition.

No

The device description clearly outlines physical components made of thermoplastic and stainless steel, which are hardware, not software.

Based on the provided text, the Olympus sterilization trays are not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use is to enclose medical devices for sterilization by a healthcare provider. This is a process related to the preparation and handling of medical devices, not for performing tests on biological samples to diagnose, monitor, or treat a condition.
  • Device Description: The device is a physical container (tray) designed to facilitate the sterilization process. It does not contain reagents, calibrators, controls, or other components typically associated with IVD tests.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analysis of biological samples (blood, urine, tissue, etc.)
    • Detection or measurement of analytes
    • Diagnosis, monitoring, or treatment guidance based on test results
    • Use in a laboratory setting for diagnostic purposes

The device's function is purely to enable the sterilization of other medical devices. While sterilization is a crucial step in healthcare, it is not an in vitro diagnostic procedure.

N/A

Intended Use / Indications for Use

The Olympus sterilization trays are intended to be used to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a health care provider. It is intended to allow steam sterilization of the enclosed medical device.

The qualification for sterilizing endoscopic instruments were validated with a process challenge device (PCD) by a GLP approved laboratory. The PCD has a diameter of 2 mm and a length of 1500 mm.

The Olympus sterilization trays are to be sterilized in the following cycle:

Prevacuum Steam:132°C - 134°C - 5 minutes minimum.
Drying Time:10 – 20 minutes as needed.

Product codes

KCT

Device Description

The Sterilization trays, which are the subject of this premarket notification, are as follows:

Item no.Outer dimensions WxHxD[mm]Detailed product description
A5938*595 x 61 x 295Instrument tray, with lid, for video telescope
A5951*478 x 41 x 224Insert tray, for 2.7 and 4.0 mm TruView arthroscopes
A5952*478 x 41 x 224Insert tray, for Diver-Line hand instruments
A5961*665 x 52 x 204Insert tray, for ureteroscopes, with lid
A5975*532 x 63 x 128Instrument tray, small, with lid
A5976*478 x 68 x 224Insert tray, for urology
A5977*478 x 68 x 224Insert tray, for 4 TroQ trocars
A5984*Set: A5994 and WA05974Instrument tray, for camera head and adapter
A5992*478 x 54 x 224Instrument tray, for A3336A, A2027A and A5226A
A5994*478 x 68 x 224Insert tray, for camera head and adapter
A05951A*478 x 41 x 224Insert tray, for TrueView II and mini TrueView telescopes
A05952A*665 x 65 x 204Instrument tray, for SonoSurg instruments, with lid
A05961A*405 x 95 x 200Instrument tray, for compact cystoscope and compact hysteroscope, with lid
WA05970A537 x 139 x 268Instrument tray, with lid and silicone mat
WA05971A482 x 60 x 224Insert tray, for the upper part of WA05970A, with silicone mat
WA05972A480 x 47 x 224Insert tray, for 5 HiQ shafts and jaw inserts
WA05973A460 x 39 x 207Insert tray, for the bottom of WA05970A, with silicone mat
WA05974A488 x 31 x 235Lid, for insert trays
WA05980A438 x 176Spare mat, nubbly, silicone, for WA05970A and WA05971A
WA05981A400 x 175Spare mat, nubbly, silicone, for WA05973A
WA05990A446 x 88 x 49Instrument tray, for two telescopes, with lid
WA05994A*478 x 68 x 224Insert tray, for camera head and adapter
WA05995A*478 x 68 x 224Insert tray, pediatric urology
WA05980A*595 x 61 x 295Instrument tray, for video telescope

The Olympus sterilization trays consist of perforated bottoms with or without perforated lids. The material of the bottom is thermoplastic, the material of the lid is thermoplastic with handles and locking tabs made from medical grade stainless steel. The silicone mats for fixture of the instruments are perforated for aeration.

The stripes are designed for minimal contact area with instruments and secure fixing.

Olympus sterilization trays will be sold non-sterile and can be reused after proper cleaning and sterilization.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

health care provider

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

The qualification for sterilizing endoscopic instruments were validated with a process challenge device (PCD) by a GLP approved laboratory. The PCD has a diameter of 2 mm and a length of 1500 mm.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

PolyVac Delivery Systems (K012105)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.6850 Sterilization wrap.

(a)
Identification. A sterilization wrap (pack, sterilization wrapper, bag, or accessories, is a device intended to be used to enclose another medical device that is to be sterilized by a health care provider. It is intended to allow sterilization of the enclosed medical device and also to maintain sterility of the enclosed device until used.(b)
Classification. Class II (performance standards).

0

033222

AUG - 2 2004

510(k) Summary Olympus Sterilization Trays

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of SMDA 1990 and 21 CFR Part 807.92

A. Submitter's Name, Address, Phone, Contact Person and Summary Date

| Manufacturer of subject device: | Olympus Winter & Ibe
Kuehnstr. 61
D-22045 Hamburg
Germany |
|---------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Registration number: | 8010313 |
| Contact Person: | Tina Steffanie-Oak
Olympus America Inc.
Two Corporate Center Drive
Melville NY 11747-3157
Registration Number: 2429304
Telephone: (631) 844-5477 |
| B. Device Name | |
| Device Name: | Olympus sterilization trays |
| Common/Usual Name: | Sterilization container |
| Classification Name: | Sterilization container |
| Classification: | 21 CFR 882.1480
Class II |

C. Predicate Devices:

PolyVac Delivery Systems (K012105)

D. Device Description

The Sterilization trays, which are the subject of this premarket notification, are as follows:

1

| Item no. | Outer dimensions
WxHxD[mm] | Detailed product description |
|-----------|-------------------------------|----------------------------------------------------------------------------|
| A5938* | 595 x 61 x 295 | Instrument tray, with lid, for video telescope |
| A5951* | 478 x 41 x 224 | Insert tray, for 2.7 and 4.0 mm TruView arthroscopes |
| A5952* | 478 x 41 x 224 | Insert tray, for Diver-Line hand instruments |
| A5961* | 665 x 52 x 204 | Insert tray, for ureteroscopes, with lid |
| A5975* | 532 x 63 x 128 | Instrument tray, small, with lid |
| A5976* | 478 x 68 x 224 | Insert tray, for urology |
| A5977* | 478 x 68 x 224 | Insert tray, for 4 TroQ trocars |
| A5984* | Set: A5994 and WA05974 | Instrument tray, for camera head and adapter |
| A5992* | 478 x 54 x 224 | Instrument tray, for A3336A, A2027A and A5226A |
| A5994* | 478 x 68 x 224 | Insert tray, for camera head and adapter |
| A05951A* | 478 x 41 x 224 | Insert tray, for TrueView II and mini TrueView telescopes |
| A05952A* | 665 x 65 x 204 | Instrument tray, for SonoSurg instruments, with lid |
| A05961A* | 405 x 95 x 200 | Instrument tray, for compact cystoscope and compact hysteroscope, with lid |
| WA05970A | 537 x 139 x 268 | Instrument tray, with lid and silicone mat |
| WA05971A | 482 x 60 x 224 | Insert tray, for the upper part of WA05970A, with silicone mat |
| WA05972A | 480 x 47 x 224 | Insert tray, for 5 HiQ shafts and jaw inserts |
| WA05973A | 460 x 39 x 207 | Insert tray, for the bottom of WA05970A, with silicone mat |
| WA05974A | 488 x 31 x 235 | Lid, for insert trays |
| WA05980A | 438 x 176 | Spare mat, nubbly, silicone, for WA05970A and WA05971A |
| WA05981A | 400 x 175 | Spare mat, nubbly, silicone, for WA05973A |
| WA05990A | 446 x 88 x 49 | Instrument tray, for two telescopes, with lid |
| WA05994A* | 478 x 68 x 224 | Insert tray, for camera head and adapter |
| WA05995A* | 478 x 68 x 224 | Insert tray, pediatric urology |
| WA05980A* | 595 x 61 x 295 | Instrument tray, for video telescope |

The Olympus sterilization trays consist of perforated bottoms with or without perforated lids. The material of the bottom is thermoplastic, the material of the lid is thermoplastic with handles and locking tabs made from medical grade stainless steel. The silicone mats for fixture of the instruments are perforated for aeration.

The stripes are designed for minimal contact area with instruments and secure fixing.

2

Olympus sterilization trays will be sold non-sterile and can be reused after proper cleaning and sterilization.

E. Intended Use of Device

The Olympus sterilization trays are intended to be used to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a health care provider. It is intended to allow steam sterilization of the enclosed medical device.

The qualification for sterilizing endoscopic instruments were validated with a process challenge device (PCD) by a GLP approved laboratory. The PCD has a diameter of 2 mm and a length of 1500 mm.

The Olympus sterilization trays are to be sterilized in the following cycle:

Prevacuum Steam:

Drying Time:

Comparison to Predicate Devices

SubjectPredicate
Olympus Sterilization
TraysPoly Vac's Delivery
Systems
ELEMENT
Intended Use: to enclose
medical devices during steam sterilization.YesYes
Intended to be reusedYesYes
Material CompositionThermoplastic RADEL®Thermoplastic RADEL®
Consist of base with lid, lid can be fastened
to the base by a locking tabYesYes
Usable with silicone mats or special silicone
holdersYesYes
PERFORMANCE
Sterilant Pentration for Steam with
Prevacuum validatedYesYes
Microbial Barrier PropertiesTo be used with approved
sterilization wrapTo be used with approved
sterilization wrap
Material CompatibilityCompatible to Steam
Sterilization at 134°CCompatible to Steam
Sterilization at 132°C
Toxicological PropertiesMaterial biocompatibleMaterial biocompatible
Shelf Lifedepends on wrapping
material and storage
conditions.n.a.
Drying time10 - 20 minutes20 - 40 minutes

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the top half of the circle. Inside the circle is a stylized image of an eagle with its wings spread, symbolizing the department's mission to protect the health of all Americans.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG - 2 2004

Olympus Winter & Ibe GmbH C/O Ms. Tina Steffanie-Oak Olympus America, Incorporated Two Corporate Center Drive Melville, New York 11747-3157

Re: K033222

Trade/Device Name: Olympus Sterilization Trays Regulation Number: 21 CFR 880.6850 Regulation Name: Sterilization Wrap Regulatory Class: II Product Code: KCT Dated: May 20, 2004 Received: May 21, 2004

Dear Ms. Steffanie-Oak:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device mendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

4

Page 2 - Steffanie-Oak

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements incan that I DAT has mace a development regulations administered by other Federal agencies. 01 the Act of any 1 ederal states and equirements, including, but not limited to: registration 1 ou inust comply was 807); labeling (21 CFR Part 801); good manufacturing practice alle listing (21 CF Part 801), and 1001), and many (QS) regulation (21 CFR Part 820); and if requirements as set form in the quality significal (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) This letter will anon you to objan middle substantial equivalence of your device to a premarket notification. - The PDF results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), if you desire specific acroof Compliance at (301) 594-4618. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the may overn of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Clus

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

510(k) Number (if known): K033222 Olympus Sterilization Trays Device Name: Indications for Use:

The Olympus sterilization trays are intended to be used to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a health care provider. It is intended to allow steam sterilization of the enclosed medical device.

The qualification for sterilizing endoscopic instruments were validated with a process challenge device (PCD) by a GLP approved laboratory. The PCD has a diameter of 2 mm and a length of 1500 mm.

The Olympus sterilization trays are to be sterilized in the following cycle:

Prevacuum Steam:132°C - 134°C - 5 minutes minimum.
Drying Time:10 – 20 minutes as needed.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Re Melby

esthesiology, General Hospital,

510(k) Number: K033222