K Number
K162930
Date Cleared
2017-04-21

(184 days)

Product Code
Regulation Number
878.4040
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Aero Chrome* Select Breathable Performance Surgical Gowns are sterile, single use surgical apparel intended to be worn by healthcare professionals to help protect both the patient and the healthcare worker from the transfer of microorganisms, body fluids, and particulate matter. The Aero Chrome* Select Breathable Performance Surgical Gowns meet the Level 4 requirements of the AAMI PB70:2012 Liquid Barrier classifications.

Device Description

The Aero Chrome* Select Breathable Performance Surgical Gown has a Spunbond/Film/Spunbond/Meltblown/Spunbond design (SFSMS) that provides AAMI Level 4 liquid barrier protection in the critical zones of the gown. The back of the Aero Chrome* Select Breathable Performance Surgical Gown in the non-critical zone also has the same Spunbond/Film/Spunbond/Meltblown/Spunbond fabric (SFSMS) that provides ASTM 1671 liquid barrier protection. The Aero Chrome* Select Breathable Performance Surgical Gown is single use, disposable medical device that will be provided in a variety of sizes and sterile and non-sterile packaging configurations.

AI/ML Overview

The provided text describes a medical device, the Aero Chrome* Select Breathable Performance Surgical Gown, and its equivalence to a predicate device. The information details various performance tests and their results, which serve as criteria for establishing substantial equivalence.

Here's an analysis of the acceptance criteria and study information:

1. A table of acceptance criteria and the reported device performance

Acceptance Criteria (Standard/Reference & Test Method)Reported Device PerformanceMeets Requirement
16 CFR 1610 (Flammability for Clothing Textiles)FlammabilityPass
ISO 10993-5:2009 (Biological Evaluation of Medical Devices - Part 5: Cytotoxicity)CytotoxicityPass (non-cytotoxic)
ISO 10993-10:2010 (Biological Evaluation of Medical Devices - Part 10: Skin Irritation Study)IrritationPass (negligible irritant)
ISO 10993-10:2010 (Biological Evaluation of Medical Devices - Part 10: Sensitization Test)SensitizationPass (non-sensitizing)
ISO 10993-7:2008 (Ethylene Oxide sterilization residuals)EO residualsPass
ISO 11810-1 (2005) (Laser Ignition Resistance)Laser resistancePass
AAMI PB70:2012 Level 4 (Liquid Barrier Performance in Critical Zone)Resistance to Penetration by Blood-Borne Pathogens Using Phi-X174 BacteriophagePass
AAMI PB70:2012 Level 1 (Liquid Barrier Performance in non-critical raglan sleeve to shoulder seams)Water resistancePass
ASTM F1671 (Liquid Barrier Performance in Non-Critical Zone fabric on the back of gown)Resistance to Penetration by Blood-Borne Pathogens Using Phi-X174 BacteriophagePass
ASTM D5034 (2009) (Grab Tensile, Peak Stretch, and Peak Energy - Nonwovens)Tensile StrengthPass
WSP 20.5 (2008) (Abrasion Resistance and Surface Bonding of SMS Laminates)Abrasion resistancePass
ASTM-1670-08 (2008) (Synthetic Blood Penetration - fabric only in critical and non-critical zone)Resistance to penetrationPass
D3776 (2009) (Mass Per Area (Basis Weight) of Materials)Fabric basis weightPass
WSP 70.4 (2008) (Water Vapor Transmission Rate Through Nonwovens and Plastic Films)Water Vapor TransmissionPass
STM-00197 (2010) (Degree Peel Strength of Laminated Nonwovens - Raw Materials)Peel StrengthPass
INDA WSP 160.1 (2009) (Resistance to Linting Dry Particle Generation)ParticulatePass

2. Sample size used for the test set and the data provenance:

The document does not explicitly state the sample sizes used for each specific test (e.g., number of gowns, or material samples tested per batch). It only lists the tests performed and that the product "met the predetermined specifications."

The data provenance is industrial testing data, generated by Halyard Health, Inc. or its designated testing facilities, to demonstrate compliance with relevant industrial standards and regulations (e.g., AAMI, ISO, ASTM, CFR). The testing appears to be prospective in nature as it is being conducted to demonstrate the performance of a new device.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience):

This information is not applicable. The device is a surgical gown, and its performance is evaluated against objective, standardized physical and biological parameters, not subjective expert assessment as would be the case for an AI diagnostic tool.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

This information is not applicable for this type of device and testing. The tests involve quantifiable measurements according to established methods, not subjective interpretations requiring adjudication.

5. 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:

This is not applicable. MRMC studies are typically for diagnostic imaging devices where human interpretation is involved. This device is a surgical gown.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done:

This is not applicable, as this is a physical medical device (surgical gown), not a software algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

The "ground truth" for this device is defined by the established industry standards and regulatory requirements for surgical apparel. These standards specify objective, measurable performance criteria (e.g., liquid barrier effectiveness, flammability, biocompatibility).

8. The sample size for the training set:

This is not applicable. This is not a machine learning or AI device that requires a training set. The device's performance is tested against predetermined physical and biological standards.

9. How the ground truth for the training set was established:

This is not applicable, as there is no training set for this type of device. The ground truth for evaluating the device is based on established scientific and regulatory standards.

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Image /page/0/Picture/1 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal features the department's name in a circular arrangement around a symbol. The symbol consists of three stylized human profiles facing right, stacked on top of each other. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

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

April 21, 2017

Halyard Health, Inc. David M. Lee, JD Associate Director, Regulatory Affairs 5405 Windward Parkway Alpharetta, Georgia 30004

Re: K162930

Trade/Device Name: Aero Chrome* Select Breathable Performance Surgical Gown Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: II Product Code: FYA Dated: March 15, 2017 Received: March 17, 2017

Dear David M. Lee:

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 either 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.

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 devicerelated 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.

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If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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,

Michael J. Ryan -S

for Tina Kiang, Ph.D. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug AdministrationForm Approved: OMB No. 0910-0120
Indications for UseExpiration Date: January 31, 2017
See PRA Statement below.
510(k) Number (if known)K162930
Device NameAero Chrome* Select Breathable Performance Surgical Gown
Indications for Use (Describe)
The Aero Chrome* Select Breathable Performance Surgical Gowns are sterile, single use surgical apparel intended to be worn by healthcare professionals to help protect both the patient and the healthcare worker from the transfer of microorganisms, body fluids, and particulate matter. The Aero Chrome* Select Breathable Performance Surgical Gowns meet the Level 4 requirements of the AAMI PB70:2012 Liquid Barrier classifications.
Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C)
CONTINUE ON A SEPARATE PAGE IF NEEDED.
This section applies only to requirements of the Paperwork Reduction Act of 1995.
DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.
The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:
Department of Health andHuman Services Food andDrug AdministrationOffice of Chief InformationOfficer PaperworkReduction Act (PRA) StaffPRAStaff@fda.hhs.gov
"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."
FORM FDA 3881 (8/14)Page 1 of 1EFPSC Publishing Services (301) 443-6740

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510(k) Summary

Date Summarywas Prepared:April 14, 2017
510(k)Submitter:David M. Lee, JDAssociate Director of Regulatory AffairsHALYARD HEALTH5405 Windward ParkwayAlpharetta, GA 30004470 448 5182David.lee@hyh.com
Primary Contactfor this 510(k)Submission:David M. Lee, JDAssociate Director of Regulatory Affairs,HALYARD HEALTH5405 Windward ParkwayAlpharetta, GA 30004470 448 5182David.lee@hyh.com
Device TradeName:Aero Chrome* Select Breathable Performance Surgical Gown(hereinafter described as "Aero Chrome* Select")
Device CommonNamesSurgical Gown
Regulation:878.4040
Device ProductCodes andClassificationNames:FYAClass IISurgical Apparel
Predicate DeviceThe Aero Chrome* Select Breathable Performance SurgicalGown under submission is substantially equivalent to thepredicate device, the Aero Chrome* Breathable PerformanceSurgical Gown (K153255).
DeviceDescription:The Aero Chrome* Select Breathable Performance SurgicalGown has a Spunbond/Film/Spunbond/Meltblown/Spunbonddesign (SFSMS) that provides AAMI Level 4 liquid barrierprotection in the critical zones of the gown. The back of theAero Chrome* Select Breathable Performance SurgicalGown in the non-critical zone also has the sameSpunbond/Film/Spunbond/Meltblown/Spunbond fabric (SFSMS)that provides ASTM 1671 liquid barrier protection. The AeroChrome* Select Breathable Performance Surgical Gown issingle use, disposable medical device that will be provided in a

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variety of sizes and sterile and non-sterile packaging configurations.

  • The Aero Chrome* Select Breathable Performance Surgical Gowns Intended Use: are sterile, single-use surgical apparel intended to be worn by healthcare professionals to help protect both the patient and the healthcare worker from the transfer of microorganisms, body fluids, and particulate matter. The Aero Chrome* Select Breathable Performance Surgical Gowns meet the Level 4 requirements of the AAMI PB70:2012 Liquid Barrier classifications.

Product Codes and Descriptions

STERILE CODES

PRODUCT STOCK CODEDESCRIPTIONSIZE
44699Aero Chrome* SelectBreathable PerformanceSurgical GownLarge
44706Aero Chrome* SelectBreathable PerformanceSurgical GownX Large
44707Aero Chrome* SelectBreathable PerformanceSurgical GownXX Large

NON-STERILE CODES

PRODUCT STOCK CODEDESCRIPTIONSIZE
44696NSAero Chrome* SelectBreathable PerformanceSurgical GownLarge
44697NSAero Chrome* SelectBreathable PerformanceSurgical GownX Large
44698NSAero Chrome* SelectBreathable PerformanceSurgical GownXX Large

Summary of Non-Clinical Testing

Standard or ReferenceTest MethodDataGeneratedMeetsRequirement
Standard for the Flammability for ClothingTextiles16 CFR 1610FlammabilityPass
Standard or ReferenceTest MethodDataGeneratedMeetsRequirement
ISO 10993-5:2009 Biological Evaluation ofMedical Devices-Part 5:CytotoxicityCytotoxicityPass, under theconditions of thestudy non-cytotoxic
ISO 10993-10:2010 Biological Evaluation ofMedical Devices-Part 10Skin IrritationStudyIrritationPass, under theconditions of thestudy anegligible irritant
ISO 10993-10:2010 Biological Evaluation ofMedical Devices-Part 10Sensitization TestSensitizationPass, under theconditions of thestudy non-sensitizing
ISO 10993-7:2008, Ethylene Oxidesterilization residualsEO residualsEO residualsPass
Laser Ignition ResistanceISO 11810-1 (2005)LaserresistancePass
AAMI Liquid Barrier Performance in CriticalZone(body, sleeves, and ties)AAMI PB70:2012Level 4Resistance toPenetration byBlood-BornePathogensUsing Phi-X174BacteriophagePass
AAMI Liquid Barrier Performance Level 1 innon-critical raglan sleeve to shoulder seamsAAMI PB70:2012Level 1WaterresistancePass
Liquid Barrier Performance in Non-CriticalZone fabric on the back of gownASTM F1671Resistance toPenetration byBlood-BornePathogensUsing Phi-X174BacteriophagePass
Grab Tensile, Peak Stretch, and PeakEnergy - NonwovensASTM D5034(2009)TensileStrengthPass
Abrasion Resistance and Surface Bonding ofSMS LaminatesWSP 20.5 (2008)AbrasionresistancePass
Synthetic Blood Penetration(fabric only in critical and non-critical zone)ASTM-1670-08(2008)Resistance topenetrationPass
Mass Per Area ( Basis Weight ) of MaterialsD3776 (2009)Fabric basisweightPass
Water Vapor Transmission Rate ThroughNonwovens and Plastic FilmsWSP70.4 (2008)Water VaporTransmissionPass
Degree Peel Strength of LaminatedNonwovens - Raw MaterialsSTM-00197(2010)Peel StrengthPass
Resistance to Linting Dry Particle GenerationINDA WSP 160.1(2009)ParticulatePass

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Test results established that the product met the predetermined specifications.

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Substantial Equivalence Table

AttributePredicate Device: K153255Aero Chrome* BreathablePerformance Surgical Gown (AAMILiquid Barrier Level 4)Device under submission: AeroChrome* Select BreathablePerformance Surgical Gown(AAMI Liquid Barrier Level 4)
Indicationsfor UseThe Aero Chrome* BreathablePerformance Surgical Gowns aresterile, single use surgical apparelintended to be worn by healthcareprofessionals to help protect both thepatient and the healthcare worker fromthe transfer of microorganisms, bodyfluids, and particulate matter. The AeroChrome* Breathable PerformanceSurgical Gowns meet the Level 4requirements of the AAMI PB70:2012Liquid Barrier classifications.The Aero Chrome* BreathablePerformance Surgical Gowns are alsosold as bulk non-sterile, single useitems, to repackager/relabelerestablishments for further packagingand Ethylene Oxide (EtO) sterilizationThe Aero Chrome* Select BreathablePerformance Surgical Gowns aresterile, single use surgical apparelintended to be worn by healthcareprofessionals to help protect both thepatient and the healthcare worker from thetransfer of microorganisms, body fluids,and particulate matter. The AeroChrome* Select BreathablePerformance Surgical Gowns meet theLevel 4 requirements of the AAMIPB70:2012 Liquid Barrier classifications.
HowsuppliedSterile (10-6) or bulk non-sterileSame
SterilizationMethodEthylene OxideSame
SAL10-6Same
Gown colorGraySame
Gown sizesSmall, Large, X-Large, XX-Large,XXX-Large, L X-Long, XXL X- LongLarge, X-Large, and XX-Large
ConstructionOverviewThe Aero Chrome* surgical gownsunder submission are manufacturedfrom a moisture-vapor breathable,repellent, non-woven fabric using apolymer blend of polypropylene andpolyethylene. The front body andsleeve fabric is a three-layer filmlaminate. This fabric is an SFSMSdesign Spunbond/Film/Spunbond-Meltblown-Spunbond that is adhesivelybonded together. The Aero Chrome*surgical gowns in the critical zone meetAAMI-4 liquid barrier requirements,while back of gown in the non-criticalzone is composed of a breathable SMSfabric with an AAMI level 1 liquidbarrier protection.Same, except the fabric on the back ofthe gown in the non-critical zone is madewith the same Spunbond/Film/Spunbond-Meltblown-Spunbond fabric (SFSMS) asused on the front of the gown in thecritical zone. This fabric on the back ofthe gown in the non-critical zone meetsASTM F1671.Overall finished gown dimensions are notchanging from the predicate device.
Not madewith NaturalRubberLatexYesSame
AttributePredicate Device: Aero Chrome* Performance Surgical GownDevice under submission in this 510(k): Aero Chrome Select Breathable Performance Surgical Gowns (AAMI Liquid Barrier Level 4)
Performance Testing in Critical ZoneANSI/AAMI PB70: 2012 Level 4 Liquid Barrier Requirements - PassSame
WSP 70.4 (STM-00164)-Water Vapor Transmission Rate - PassSame
WSP 160.1 (STM-00353) Test Method for Resistance to Linting: Dry Particle Generation with a Modified Gelbo Flex Unit -PassSame
ASTM D 5034 - 2009 Standard Test Method for Breaking Strength and Elongation of Textile Fabrics (Grab Test) - PassSame
ASTM F1670:2008 for fabric in critical zone-PassSame
STM- 00149 (WSP 20.5 2008), Abrasion Resistance Test - PassSame
Biocompatibility per ISO 10993 – Pass, the device under the conditions of the study is non-cytotoxic, non-irritant, and non-sensitizing.Same, device under the conditions of the study was non-cytotoxic, non-irritant, and non-sensitizing.
16 CFR, Chapter II--Consumer Product Safety Commission Part 1610 -Standard for The Flammability of Clothing Textiles Class I - PassSame
Laser Ignition Resistance/ ISO 11810- PassSame
Performance Testing on fabric in Non-Critical Zone on back of gownAAMI level 1-Pass

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Performance Testing

Conclusion The performance testing submitted for the Aero Chrome* Select Breathable Performance Surgical Gown demonstrates substantial equivalence to the predicate Aero Chrome* Breathable Performance Surgical Gown (K153255) in intended use, design, materials, performance, and biocompatibility attributes. Based on the comparisons to the predicate device, the subject device described in this 510(k) Summary, Aero Chrome* Select Breathable Performance Surgical Gown, does not raise any different questions or new issues of safety and effectiveness.

*Registered Trademark or Trademark of Halyard Health, Inc., or its affiliates.

§ 878.4040 Surgical apparel.

(a)
Identification. Surgical apparel are devices that are intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operating room personnel from transfer of microorganisms, body fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe covers, and isolation masks and gowns. Surgical suits and dresses, commonly known as scrub suits, are excluded.(b)
Classification. (1) Class II (special controls) for surgical gowns and surgical masks. A surgical N95 respirator or N95 filtering facepiece respirator is not exempt if it is intended to prevent specific diseases or infections, or it is labeled or otherwise represented as filtering surgical smoke or plumes, filtering specific amounts of viruses or bacteria, reducing the amount of and/or killing viruses, bacteria, or fungi, or affecting allergenicity, or it contains coating technologies unrelated to filtration (e.g., to reduce and or kill microorganisms). Surgical N95 respirators and N95 filtering facepiece respirators are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9, and the following conditions for exemption:(i) The user contacting components of the device must be demonstrated to be biocompatible.
(ii) Analysis and nonclinical testing must:
(A) Characterize flammability and be demonstrated to be appropriate for the intended environment of use; and
(B) Demonstrate the ability of the device to resist penetration by fluids, such as blood and body fluids, at a velocity consistent with the intended use of the device.
(iii) NIOSH approved under its regulation.
(2) Class I (general controls) for surgical apparel other than surgical gowns and surgical masks. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9.