K Number
K133554
Device Name
SURGICAL LIGHT HANDLE COVER
Date Cleared
2014-04-08

(140 days)

Product Code
Regulation Number
878.4580
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
A device intended to be used as a disposable barrier for a surgical lighting system and which allows a surgical team member to manually adjust the lighting system. This is a single-use device
Device Description
The Surgical Light Handle Cover is a polycarbonate injection molded device shaped to fit a surgical light that has release buttons protruding from the surgical light handle. The Surgical Light Handle Cover has apertures located at the end of the device, proximal to the surgical light, which correspond to the release buttons on the surgical light handle. When the Surgical Light Handle Cover is attached to the light, the release buttons will interface with the apertures to secure the Surgical Light Handle Cover to the light handle. The Surgical Light Handle Cover is hollow in the center, with transparent polycarbonate located near the distal end. The transparent end permits the use of a recording device, which may be mounted onto the surgical light. The transparent end allows light to pass through for the purpose of recording images, it does not provide image enhancement or magnification.
More Information

Not Found

No
The device description and performance studies focus on the physical properties and functionality of a disposable cover for a surgical light handle, with no mention of AI or ML.

No.
The device is a disposable barrier for a surgical lighting system and does not directly treat or diagnose a medical condition.

No

This device is described as a disposable barrier for a surgical lighting system and allows manual adjustment of the light. Its description focuses on its physical properties for attachment and compatibility, and the performance studies relate to packaging, sterility, material compatibility, and ease of use, not the diagnosis of any condition.

No

The device description clearly describes a physical, injection-molded polycarbonate device, not software.

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

Here's why:

  • Intended Use: The intended use is clearly stated as a "disposable barrier for a surgical lighting system" that allows manual adjustment. This is a physical barrier and a functional accessory for a surgical light.
  • Device Description: The description details a physical, molded device designed to fit onto a surgical light handle. It focuses on its shape, material, and how it attaches and allows for light adjustment and potential recording device use.
  • Lack of IVD Characteristics: An IVD device is used in vitro (outside the body) to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. This device does not interact with human specimens or provide diagnostic information.
  • Performance Studies: The performance studies listed (Packaging, Sterility, Material Compatibility, Functional Requirements) are typical for a sterile, disposable medical device used in a surgical setting, not for an IVD.

In summary, the device's purpose and function are entirely related to the surgical lighting system and maintaining sterility, not to analyzing biological samples for diagnostic purposes.

N/A

Intended Use / Indications for Use

A device intended to be used as a disposable barrier for a surgical lighting system and which allows a surgical team member to manually adjust the lighting system. This is a single-use device

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

FTA

Device Description

The Surgical Light Handle Cover is a polycarbonate injection molded device shaped to fit a surgical light that has release buttons protruding from the surgical light handle. The Surgical Light Handle Cover has apertures located at the end of the device, proximal to the surgical light, which correspond to the release buttons on the surgical light handle. When the Surgical Light Handle Cover is attached to the light, the release buttons will interface with the apertures to secure the Surgical Light Handle Cover to the light handle.

The Surgical Light Handle Cover is hollow in the center, with transparent polycarbonate located near the distal end. The transparent end permits the use of a recording device, which may be mounted onto the surgical light. The transparent end allows light to pass through for the purpose of recording images, it does not provide image enhancement or magnification.

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)

Performance Data Summary

Table 2: Performance Data Summary of the Surgical Light Handle Cover

RequirementSpecificationMethodResult
PackagingSimulated Distribution-TestASTM D4169Pass
Dye Migration TestASTM F1929Pass
Seal Peel TestASTM F88Pass
Inspection for Shipping DamageVisual InspectionPass
SterilitySAL 10-6ISO 11135-1Pass
EO/ECH ResidualsISO 10993-7Pass
Material Compatibility EvaluationCytotoxicityISO ElutionPass
Material LeachablesUSP Physical-Chemical AnalysisPass
Functional RequirementsProduct must be easily installed and removedAttached/Detached Surgical Light Handle Cover to surgical lightPass
Product must not interfere with the functionality of surgical lightWith Surgical Light Handle Cover attached: rotate light, move light in transverse direction, compare visual clarityPass

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.

K901154

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

§ 878.4580 Surgical lamp.

(a)
Identification. A surgical lamp (including a fixture) is a device intended to be used to provide visible illumination of the surgical field or the patient.(b)
Classification. Class II (special controls). The device, when it is an operating room lamp, a surgical instrument light, a surgical floor standing light, an endoscopic surgical light, a surgical light connector, a ceiling mounted surgical light, a surgical light carrier, surgical light accessories, a surgical lamp, a remote illuminator, or an incandescent surgical lamp, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

0

Image /page/0/Picture/1 description: The image shows the logo for Ecolab Inc. The text "Ecolab Inc." is at the top of the image. Below that is the Ecolab logo, with the word "ECOLAB" in bold black letters and a symbol in the middle of the O. There is a registered trademark symbol to the right of the B.

:

APR 0 8 2014 K133554

Section 5: 510(k) Summary

Surgical Light Handle Cover

As required by 21 CFR 807.92.

Date:November 11, 2013
Administrative Information
Submitter:Microtek Medical Inc., an Ecolab Company
Establishment
Registration Number:1043582.
Contact Person:Andy Roller
370 Wabasha Street North
St. Paul, MN 55102-1390
Sr. Regulatory Specialist
651.293.2080
Device Identification
Device Name:Surgical Light Handle Cover
Common Name:Surgical Light Accessory
Device Classification Name:Light, Surgical, Accessories
Device Classification:Class II
Panel:General and Plastic Surgery
Classification Regulation:878.4580
Product Code:FTA

Performance Standards: No Recognized Consensus Standards

1

Ecolab Inc.

Surgical Light Handle Cover

Predicate Device:Surgical Lamp Handle and Cover, cleared on 3/20/1999 via K901154
Trade Name:Skytron Disposable Light Handle Cover

Device Description

The Surgical Light Handle Cover is a polycarbonate injection molded device shaped to fit a surgical light that has release buttons protruding from the surgical light handle. The Surgical Light Handle Cover has apertures located at the end of the device, proximal to the surgical light, which correspond to the release buttons on the surgical light handle. When the Surgical Light Handle Cover is attached to the light, the release buttons will interface with the apertures to secure the Surgical Light Handle Cover to the light handle.

The Surgical Light Handle Cover is hollow in the center, with transparent polycarbonate located near the distal end. The transparent end permits the use of a recording device, which may be mounted onto the surgical light. The transparent end allows light to pass through for the purpose of recording images, it does not provide image enhancement or magnification.

Statement of Intended Use

The Surgical Light Handle Cover is intended to be used as a disposable barrier for a surgical lighting system and which allows the surgical team member to manually adjust the lighting system. This is a single-use device.

Substantial Equivalence Discussion

The predicate device and design basis for the Surgical Light Handle Cover is the Microtek Medical Surgical Lamp Handle and Cover (K901154, cleared 3/20/1990). The fundamental scientific technology of the device remains unchanged in that it is a disposable sterile light cover that allows the user to adjust position of the light during surgical procedures. The following table illustrates the similarities and differences in the product designs.

| Property or
Characteristic | Proposed Device -
Surgical Light Handle Cover | Predicate Device -
Surgical Lamp Handle and
Cover (K901154) |
|----------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------|
| Intended
Use/Indications for
Use | A device intended to be used as a
disposable barrier for a surgical
lighting system and which allows a
surgical team member to manually | A device intended to be used as
a disposable barrier for a
surgical lighting system and
which allows a surgical team |

Table 1: Substantial Equivalence
------------------------------------------

2

| | adjust the lighting system. This is a
single-use device | member to manually adjust the
lighting system. This is a
single-use device |
|----------------------------------|------------------------------------------------------------|----------------------------------------------------------------------------------|
| Conditions of Use | Single Use, Disposable | Single Use, Disposable |
| Materials | Polycarbonate Handle Cover | Polypropylene Handle Cover |
| Property or
Characteristic | Proposed Device -
Surgical Light Handle Cover | Predicate Device -
Surgical Lamp Handle and
Cover (K901154) |
| | Color | Clear - Frosted |
| Sterility | Provided sterile | Provided sterile |
| Sterility Assurance
Level | 10-6 via EO Gas | 10-3 via Gamma Radiation |
| Principle of
Operation | Sterile cover to allow manipulation
of a surgical light | Sterile cover to allow
manipulation of a surgical light |
| Interface with
Surgical Light | Fully detachable | Lamp Handle - Not detachable
Handle Cover - Fully
detachable |
| | Transparent Distal
End | Yes |

Performance Data Summary

Table 2: Performance Data Summary of the Surgical Light Handle Cover

RequirementSpecificationMethodResult
PackagingSimulated Distribution-
TestASTM D4169Pass
Dye Migration TestASTM F1929Pass
Seal Peel TestASTM F88Pass
Inspection for Shipping
DamageVisual InspectionPass
SterilitySAL 10-6ISO 11135-1Pass
EO/ECH ResidualsISO 10993-7Pass
Material
Compatibility
EvaluationCytotoxicityISO ElutionPass
Material LeachablesUSP Physical-Chemical
AnalysisPass
Functional
RequirementsProduct must be easily
installed and removedAttached/Detached Surgical
Light Handle Cover to surgical
lightPass
Product must not interfere
with the functionality of
surgical lightWith Surgical Light Handle
Cover attached: rotate light,
move light in transverse
direction, compare visual clarityPass

3

Substantial Equivalence Conclusion

The differences between the Surgical Light Handle Cover and the predicate device do not constitute a new intended use, and the differences in technological characteristics do not raise different questions of safety and effectiveness. Furthermore, the changes to the device design do not impact the fundamental scientific technology or principle of operation, which is to allow a user to manipulate a surgical light during surgical procedures using a disposable sterile cover.

The Surgical Light Handle Cover is substantially equivalent to the predicate device cleared under K901154.

4

Image /page/4/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three lines forming its body and wings. The eagle is facing to the right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

April 8, 2014

Microtek Medical, Incorporated An Ecolab Company Mr. Andy Roller Senior Regulatory Specialist 370 Wabasha Street North St. Paul. MN 55102

Re: K133554

Trade/Device Name: Surgical Light Handle Cover Regulation Number: 21 CFR 878.4580 Regulation Name: Light, Surgical, Accessories Regulatory Class: II Product Code: FTA Dated: January 30, 2014 Received: February 12, 2014

Dear Mr. Roller:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into cither class II (Special Controls) or class III (PMA), it may be subject to 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 - Mr. Roller

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fdagov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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 (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours.

Tejashri
Clinical D
DAGRID

Teiashri Purohit-Sheth, M.D. Clinical Deputy Director

FOR

Erin I. Keith, M.S. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Statement of Indications for Use Section 4:

510(k) Number (if known): _ K133554

Device Name: Surgical Light Handle Cover

Model Number: B1-715-65

Indications For Use: A device intended to be used as a disposable barrier for a surgical lighting system and which allows a surgical team member to manually adjust the lighting system. This is a single-use device

Image /page/6/Picture/7 description: The image shows the phrase "Prescription Use (Part 21 CFR 801 Subpart D)" in bold font. There is a line underneath the phrase. Above the phrase is a large X mark.

AND/OR

Over-The-Counter Use (2) CFR 801 Subparl C)

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

Concurrence of CDRH, Office of Device Evaluation (CDDE) Elizabeth F. Claverie -S 2014.04.07 22:55:00 -04'00'

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