K Number
K083234
Device Name
KIMBERLY-CLARK KC100 SURGICAL DRAPES, MODEL KC 100, KIMBERLY-CLARK KC100 SURGICAL EQUIPMENT COVERS, MODEL KC 100
Date Cleared
2009-03-25

(142 days)

Product Code
Regulation Number
878.4370
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Kimberly-Clark Corporation intends to market the sterile KC100 Surgical Drapes as devices made of natural or synthetic material intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. Kimberly-Clark intends to market the sterile KC100 Surgical Equipment Covers which are protective barrier covers that are intended to be used to cover surgical equipment and provide a protective barrier for that equipment.
Device Description
The surgical drapes and equipment covers described in this 510(k) submission are identical in all specifications to the predicate device models identified in K080629 except for minor variations in the widths and lengths of three models.
More Information

Not Found

No
The device description and performance studies focus on material properties and barrier function, with no mention of AI/ML or related concepts.

No
The device is described as a protective covering for patients and surgical equipment, designed to prevent contamination, which is a supportive rather than a therapeutic function.

No

Explanation: The device, KC100 Surgical Drapes and Surgical Equipment Covers, is intended to provide a protective barrier during surgery to prevent contamination, not to diagnose a condition or disease.

No

The device is described as surgical drapes and equipment covers made of natural or synthetic material, which are physical products, not software.

Based on the provided text, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states the devices are for use as protective patient coverings and equipment covers during surgery to isolate from contamination. This is a physical barrier function, not a diagnostic test performed on samples from the body.
  • Device Description: The description focuses on the physical characteristics and materials of the drapes and covers.
  • Lack of IVD Indicators: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting biomarkers, or providing diagnostic information about a patient's health status.
  • Performance Studies: The performance studies focus on physical properties like barrier function, strength, and biocompatibility, which are relevant to a physical barrier device, not an IVD.

IVD devices are used to examine specimens derived from the human body to provide information for the diagnosis, prevention, monitoring, treatment, or alleviation of disease. The described surgical drapes and equipment covers do not fit this definition.

N/A

Intended Use / Indications for Use

Kimberly-Clark* Corporation intends to market the sterile KC100 Surgical Drapes as devices made of natural or synthetic material intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. Kimberly-Clark intends to market the sterile KC100 Surgical Equipment Covers which are protective barrier covers that are intended to be used to cover surgical equipment and provide a protective barrier for that equipment.

Product codes (comma separated list FDA assigned to the subject device)

KKX, MMP

Device Description

The surgical drapes and equipment covers described in this 510(k) submission are identical in all specifications to the predicate device models identified in K080629 except for minor variations in the widths and lengths of three models.

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

Not Found

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 KC100 Surgical Drapes and Equipment Covers are identical to, and meet the same acceptance testing criteria as, their predicate drapes and covers in K080629. Testing included biocompatibility (i.e., cytotoxicity, irritation, and sensitization) in compliance with the methods of ISO 10993, barrier properties, tensile and tear strength, alcohol repellency, and flammability. All results of testing met acceptance criteria.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K080629

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 878.4370 Surgical drape and drape accessories.

(a)
Identification. A surgical drape and drape accessories is a device made of natural or synthetic materials intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. The device includes a plastic wound protector that may adhere to the skin around a surgical incision or be placed in a wound to cover its exposed edges, and a latex drape with a self-retaining finger cot that is intended to allow repeated insertion of the surgeon's finger into the rectum during performance of a transurethral prostatectomy.(b)
Classification. Class II (special controls). The device, when it is an ear, nose, and throat surgical drape, a latex sheet drape with self-retaining finger cot, a disposable urological drape, a Kelly pad, an ophthalmic patient drape, an ophthalmic microscope drape, an internal drape retention ring (wound protector), or a surgical drape that does not include an antimicrobial agent, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

0

K083234

510(k) Summary for the Kimberly-Clark* Corporation KC100 Surgical Drapes and Equipment Covers

MAR 2 5 2009

| Date Summary

was Prepared:October 31, 2008
510(k) Submitter:Thomas Kozma
Director, Regulatory Affairs
Kimberly-Clark Health Care
1400 Holcomb Bridge Road
Roswell, GA 30076
Ph: 770.587.8393
FAX: 920.225.3408
Email: thomas.kozma@kcc.com
Primary Contact
for this 510(k)
Submission:Lisa Peacock, Consultant to Kimberly-Clark Health Care
SciMed, Inc.
Ph: 706.216.3413
FAX: 800.713.7754
Email: lisa.peacock@kcc.com
Device Common
Name:Sterile surgical drapes and surgical equipment covers
Device Product
Codes and
Classification
Names:KKX Surgical Drapes
MMP Protective Barrier Covers
Intended Use:Kimberly-Clark Corporation intends to market the sterile
KC100 Surgical Drapes as devices made of natural or
synthetic material intended to be used as a protective
patient covering, such as to isolate a site of surgical incision
from microbial and other contamination. Kimberly-Clark
intends to market the sterile KC100 Surgical Equipment
Covers which are protective barrier covers that are
intended to be used to cover surgical equipment and
provide a protective barrier for that equipment.
Predicate
Devices:K080629 proMedical Surgical Drapes and proMedical
Surgical Equipment Covers
Substantial
Equivalence:The surgical drapes and equipment covers described in this
510(k) submission are identical in all specifications to the
predicate device models identified in K080629 except for
minor variations in the widths and lengths of three models.

Page 1 of 2 - Section 6 510(k) Summary

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Summary of Testing:

The KC100 Surgical Drapes and Equipment Covers are identical to, and meet the same acceptance testing criteria as, their predicate drapes and covers in K080629. Testing included biocompatibility (i.e., cytotoxicity, irritation, and sensitization) in compliance with the methods of ISO 10993, barrier properties, tensile and tear strength, alcohol repellency, and flammability. All results of testing met acceptance criteria.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

NAR 2 5 20080

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kimberly-Clark Corporation C/o Ms. Lisa Peacock, RAC Consultant to Kimberly-Clark Health Care SciMed, Incorporated 172 Conductor Drive Dawsonville, Georgia 30534

Re: K083234

Trade/Device Name: KC100 Surgical Drapes & KC100 Surgical Equipment Covers Regulation Number: 21 CFR 878.4370 Regulation Name: Surgical Drape and Drape Accessories Regulatory Class: II Product Code: KKX Dated: February 23, 2009 Received: February 25, 2009

Dear Ms. Peacock:

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 Amendments, 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.

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Page 2 - Ms. Peacock

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 of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (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) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device 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), please contact the Center for Devices and Radiological Health's (CDRH's) Office of Compliance at (240) 276-0115. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Anthony D. naton bu

Ginette Y. Michaud, M.D. Acting Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): K083234

Device Name: KC100 Surgical Equipment Covers

Indications for Use:

Kimberly-Clark* Corporation intends to market the sterile KC100 Surgical Equipment Covers which are protective barrier covers that are intended to be used to cover surgical equipment and provide a protective barrier for that equipment.

| Product Name | Model
Code | Cover Materials |
|------------------|-------------------------|-----------------------------------------------|
| Mayo Stand Cover | 88656 | Blue polyethylene with air-laid reinforcement |
| Table Cover | 88673
88666
89564 | Blue polyethylene with air-laid reinforcement |

Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use _ X (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Shale H. Murphy, ID

(Division Sign-Oft) Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K083234

5

Indications for Use

510(k) Number (if known): K083234

Device Name: KC100 Surgical Drapes

Indications for Use:

Kimberly-Clark* Corporation intends to market the sterile KC100 Surgical Drapes as devices made of natural or synthetic material intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. See Page 2 for product list.

Prescription Use (Part 21 CFR 801 Subpart D) 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)

Shule A. Murphy 18
(Division Sign-Off)

Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K083234

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Indications for Use Product List

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Product NameModel CodeDrape Materials
Angiography Surgical Drape89583SMS base panel with air-laid pad and polyethylene
Clear Legging Surgical Drape89195Polyethylene
Universal Extremity Surgical
Drape89191SMS base panel with air-laid pad
Legging Surgical Drape70093855SMS panel
Head Surgical Drape70093879SMS panel
Side Surgical Drape89556SMS base panel with air-laid pad
Top Surgical Drape89554SMS base panel with air-laid pad
Bottom Surgical Drape89555SMS base panel with air-laid pad
Bar Surgical Drape89533SMS base panel with air-laid pad
Arthroscopy Surgical Drape88661SMS base panel with polyethylene
Under Buttocks Surgical Drape89584SMS base panel with air-laid pad and polyethylene
Split EENT Surgical Drape89197SMS base panel with air-laid pad
Lithotomy Surgical Drape89198SMS base panel with air-laid pad
Laparoscopy T Surgical Drape89199SMS base panel with air-laid pad
Thyroid Surgical Drape89539SMS base panel with air-laid pad
Minor Procedure Surgical
Drape89531SMS base panel with air-laid pad
Lap Chole Surgical Drape89538SMS base panel with air-laid pad
Cystoscopy T Surgical Drape89196SMS base panel with air-laid pad
Chest Surgical Drape89561SMS base panel with air-laid pad
Utility Surgical Drape89536Air-laid absorbent panel
Split Surgical Drape89190Polyethylene
U Surgical Drape89532SMS base panel with air-laid pad
Laparotomy Surgical Drape89537SMS base panel with air-laid pad
Shoulder Arthroscopy Surgical
Drape89558SMS base panel with polyethylene
Body Split Surgical Drape89560SMS base panel with air-laid pad and polyethylene
Body Split Surgical Drape89557SMS base panel with air-laid pad
Half Surgical Drape89534SMS panel
Large Surgical Drape79535SMS panel
Universal Spine Surgical Drape89193SMS base panel with air-laid pad and polyethylene
Dental Surgical Drape89543SMS base panel with air-laid pad
Stockinette Surgical Drape044001-700Polyethylene stockinette

and the comments of the country