K Number
K121919
Date Cleared
2013-02-14

(227 days)

Product Code
Regulation Number
878.4370
Panel
HO
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Exact Medical Manufacturing Surgical Drape AAMI Level 4 are sterile or non-sterile single use devices 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 EMM Surgical Drapes AAMI Level 4 are also sold as bulk non-sterile, single use items, to repackager/relabeler establishments for further packaging and ethylene oxide sterilization according to ISO 11135-1:2007

Device Description

Exact Medical Manufacturing Surgical Drape AAMI Level 4 are sterile or non-sterile single use devices 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.
Exact Medical Manufacturing Surgical Drape with AAMI Liquid Barrier Level The base sheet fabric is a three layer composite comprised of polypropylene spunbond and a co-extruded PE film. Layers are thermally bonded together producing a single layer with various basis weights. The outer layers are non woven fabric, the inner layer is AAMI PB:70 Level 4 capable PE film.

AI/ML Overview

The provided document K121919 describes a surgical drape, not an AI/ML powered medical device. Therefore, many of the requested categories for AI/ML devices (e.g., sample sizes for test/training sets, number of experts, adjudication methods, MRMC studies, standalone performance) are not applicable.

However, I can extract the acceptance criteria and performance data for this physical medical device based on the information provided.

1. Table of Acceptance Criteria and Reported Device Performance

TestAcceptance Criteria (Predicate Device K102666)Reported Device Performance (Exact Medical Manufacturing Surgical Drape with AAMI Liquid Barrier Level IV)
Barrier PerformanceAAMI PB70: Level 4AAMI PB70: Level 4
BiocompatibilityCytotoxicity, Primary Skin Irritation, Sensitization testsISO 10993-5:2009 Cytotoxicity, ISO 10993-10:2002 Skin Irritation, ISO 10993-10:2002 Sensitization
Tear Strength (ASTM 5587-08)Unknown/Equivalent to Predicate19.4 lbs & 9.7 lbs
Breaking Strength (ASTM D5034-09)Unknown/Equivalent to Predicate24.4 lbs & 15.9 lbs
Flammability (16CFR1610:2007)Class 1Class 1
Linting (ISO 9073-10:2003)Unknown/Equivalent to PredicateReported as 'Substantially Equivalent' to predicate, implying it met predicate's (unknown) criteria
SterilitySterile via EO GasSterile (via EO Gas) ISO 11135-1:2007

Study Proving Device Meets Acceptance Criteria:

The study proving the device meets the acceptance criteria is a "Summary of Testing" described in the 510(k) submission. It states:

"Exact Medical Manufacturing Surgical Drape with AAMI Liquid Barrier Level IV is substantially equivalent and meets the same acceptance criteria as the predicate device/Drape in K102666 Non-clinical performance testing includes: Biocompatibility (cytotoxicity, irritation, sensitization) in compliance with the methods of ISO 10993, Barrier properties- AAMI PB:70 Level 4, tensile, tear strength, flammability, linting and sterility. All results of the testing met acceptance criteria."

Regarding AI/ML Specific Information (Categories 2-9):

As this is a physical surgical drape, the following categories are not applicable and no information is provided in the document:

  1. Sample size used for the test set and the data provenance: Not applicable for a physical device undergoing non-clinical performance testing.
  2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable. Material properties and performance are measured against standards, not expert consensus.
  3. Adjudication method for the test set: Not applicable.
  4. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable.
  5. If a standalone (i.e. algorithm only without human-in-the loop performance) was done: Not applicable.
  6. The type of ground truth used (expert consensus, pathology, outcomes data, etc): For a physical device, the "ground truth" or reference for acceptance is established by recognized international and national standards (e.g., AAMI PB70, ISO 10993, ASTM, 16CFR1610).
  7. The sample size for the training set: Not applicable.
  8. How the ground truth for the training set was established: Not applicable.

§ 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.