K Number
K170429
Device Name
Tyvek Sterilization Pouches with Chevron Seal
Date Cleared
2017-10-27

(256 days)

Product Code
Regulation Number
880.6850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Tyvek Sterilization Pouches with Chevron Seal are intended to enclose medical devices that are to be sterilized in a single pouch configuration at a healthcare facility. They are used in the 12 hour sterilization cycle at 20-29°C in the Anprolene AN75 Ethylene Oxide Gas Sterilizer.
Device Description
Tyvek Sterilization Pouches with Chevron Seal are constructed from an uncoated Tyvek backing of fine, continuous, high-density polyethylene fibers, with front material consisting of a clear, laminated polyethylene terephthalate / low density polyethylene (LDPE) or LDPE-ethylenevinylacetate copolymer film. The pouches are used to enclose medical devices that are to be sterilized by a healthcare provider in the 12 hour sterilization cycle at 20-29°C in an Anprolene AN75 Ethylene Oxide Gas Sterilizer. Following manufacturer's instructions, devices are inserted into Tyvek Sterilization Pouches and sealed. The self-seal pouch permits sealing of the pouch without heat-sealing equipment, whereas the heat-sealable pouches must be heat sealed prior to the cycle. Andersen Sterilizers' AN85/AN86 EO Indicators, when placed on the outside of the sterilization pouches, indicate EO exposure and offer a convenient way to differentiate pouches that have been processed in EO sterilization cycles from unprocessed units. The color of the AN85/AN86 EO Indicators changes from yellow-green to blue after exposure to EO. After completion of the sterilization process, the pouches maintain sterility of the enclosed medical devices for at least 3 months (90 days).
More Information

Not Found

No
The device is a sterilization pouch and the description focuses on its physical properties and performance in sterilization, with no mention of AI or ML.

No
The device is a sterilization pouch used to enclose medical devices for sterilization and maintain their sterility, not to treat a condition or disease.

No

The device is a sterilization pouch used to enclose medical devices for sterilization and maintain their sterility, not to diagnose medical conditions or diseases.

No

The device description clearly describes a physical product (pouches made of Tyvek and film) used for enclosing medical devices for sterilization. There is no mention of software components.

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

Here's why:

  • Intended Use: The intended use is to enclose medical devices for sterilization in a healthcare facility. This is a process related to preparing medical devices for use, not for performing diagnostic tests on biological samples.
  • Device Description: The description focuses on the physical construction of the pouches and their function in the sterilization process and maintaining sterility. There is no mention of analyzing biological samples or providing diagnostic information.
  • No mention of IVD characteristics: The document lacks any of the typical characteristics of an IVD, such as:
    • Analyzing biological specimens (blood, urine, tissue, etc.)
    • Detecting or measuring analytes
    • Providing information for diagnosis, monitoring, or prognosis of a disease or condition.

The device is clearly intended as a sterilization packaging system for medical devices.

N/A

Intended Use / Indications for Use

Tyvek Sterilization Pouches with Chevron Seal are intended to enclose medical devices that are to be sterilized in a single pouch configuration at a healthcare facility. They are used in the 12 hour sterilization cycle at 20-29°C in the Anprolene AN75 Ethylene Oxide Gas Sterilizer. Critical process parameters for the cycle are summarized in Table 1.

Table 1. Critical sterilization cycle parameters in the Anprolene AN75 Ethylene Oxide Gas Sterilizer

EO AmountTemperatureRelative HumidityEO Exposure TimeTotal Cycle Time
17.6 g ± 5%20-29°C35-90%12 hours14 hours

The product codes for Tyvek Sterilization Pouches are listed in Table 2.

Table 2. Product codes for Tyvek Sterilization Pouches

Product TypeSelf-Seal, Heat Seal, Tubing
Product CodesTLP-030, TLP-031, TLP-033, TLP-058, TLP-059

The 12 hour cycle in the Anprolene AN75 Ethylene Oxide Gas Sterilizer has been validated to sterilize a load of up to 24 lbs of metal surgical instruments, 3 lbs of fabric, or 3.5 lbs of plastic devices (combined weight of pouched devices and tray). Sterility was maintained for at least 3 months after processing in an Anprolene AN75 sterilizer.

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

FRG

Device Description

Tyvek Sterilization Pouches with Chevron Seal are constructed from an uncoated Tyvek backing of fine, continuous, high-density polyethylene fibers, with front material consisting of a clear, laminated polyethylene terephthalate / low density polyethylene (LDPE) or LDPE-ethylenevinylacetate copolymer film. The pouches are used to enclose medical devices that are to be sterilized by a healthcare provider in the 12 hour sterilization cycle at 20-29°C in an Anprolene AN75 Ethylene Oxide Gas Sterilizer. Following manufacturer's instructions, devices are inserted into Tyvek Sterilization Pouches and sealed. The self-seal pouch permits sealing of the pouch without heat-sealing equipment, whereas the heat-sealable pouches must be heat sealed prior to the cycle. Andersen Sterilizers' AN85/AN86 EO Indicators, when placed on the outside of the sterilization pouches, indicate EO exposure and offer a convenient way to differentiate pouches that have been processed in EO sterilization cycles from unprocessed units. The color of the AN85/AN86 EO Indicators changes from yellow-green to blue after exposure to EO. After completion of the sterilization process, the pouches maintain sterility of the enclosed medical devices for at least 3 months (90 days).

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

healthcare facility

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 testing was conducted to demonstrate that Tyvek Sterilization Pouches with Chevron Seal perform as intended to allow sterilization of the enclosed medical devices. Sterilization efficacy testing demonstrated a 12-Log reduction and a sterility assurance level of 10-6 using the half dose validation method under worst-case conditions. Tyvek Sterilization Pouches with Chevron Seal also maintain sterility of the enclosed devices as intended. Shelf life studies demonstrated after completion of the Anprolene AN75 sterilization process, sterility is maintained for at least 3 months.

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

Sterilization efficacy: a 12-Log reduction and a sterility assurance level of 10-6.
Maintenance of sterility: at least 3 months.

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.

K152058

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

§ 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

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services seal on the left and the FDA acronym followed by the words "U.S. FOOD & DRUG ADMINISTRATION" on the right. The FDA part of the logo is in blue, with the acronym in a larger font size than the rest of the text.

October 27, 2017

Andersen Sterilizers, Inc. William Andersen President 3154 Caroline Drive Haw River, North Carolina 27258

Re: K170429

Trade/Device Name: Tyvek Sterilization Pouches with Chevron Seal Regulation Number: 21 CFR 880.6850 Regulation Name: Sterilization Wrap Regulatory Class: Class II Product Code: FRG Dated: September 28, 2017 Received: October 6, 2017

Dear William Andersen:

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 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.

U.S. Food & Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 www.fda.qov

1

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 (DICE) at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevicesforYou/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 (DICE) 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

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K170429

Device Name

Tyvek® Sterilization Pouches with Chevron Seal

Indications for Use (Describe)

Tyvek Sterilization Pouches with Chevron Seal are intended to enclose that are to be sterlized in a single pouch configuration at a healthcare facility. They are used in the 12 hour sterlization cycle at 20-29°C in the Anprolene AN75 Ethylene Oxide Gas Sterilizer. Critical process parameters for the cycle are summarized in Table 1.

Table 1. Critical sterilization cycle parameters in the Anprolene AN75 Ethylene Oxide Gas Sterilizer

EO AmountTemperatureRelative HumidityEO Exposure TimeTotal Cycle Time
17.6 g ± 5%20-29°C35-90%12 hours14 hours

The product codes for Tyvek Sterilization Pouches are listed in Table 2.

Table 2. Product codes for Tyvek Sterilization Pouches

Product TypeSelf-Seal, Heat Seal, Tubing
Product CodesTLP-030, TLP-031, TLP-033, TLP-058, TLP-059

The 12 hour cycle in the Anprolene AN75 Ethylene Oxide Gas Sterilizer has been validated to sterilize a load of up to 24 Us of metal surgical instruments, 3 lbs of fabric, or 3.5 lbs of plastic devices (combined weight of pouched devices and tray). Sterility was maintained for at least 3 months after processing in an Anprolene AN75 sterilizer.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

3

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4

K170429 510(k) Summary

| 5.1 Applicant's Name and Address | Andersen Sterilizers, Inc.
Establishment Registration Number 3004634710
3154 Caroline Drive
Haw River, NC 27258 | |
|----------------------------------|--------------------------------------------------------------------------------------------------------------------------|------------------------------------------------|
| 5.2 Contact Person | William K. Andersen, BE, MD, FAAOS
President
Phone: 336-376-8622, Fax: 336-376-5428 | |
| 5.3 Date of Preparation | September 28, 2017 | |
| 5.4 Device | | |
| | Proprietary Name | Tyvek® Sterilization Pouches with Chevron Seal |
| | Common Name | Sterilization Pouch |
| | Classification | Class II (21 CFR 880.6850) |
| | Product Code | FRG |
| 5.5 Predicate Device | | |
| | Device Name | Tyvek Sterilization Pouches with Chevron Seal |
| | 510(k) number | K152058 |
| | Manufacturer | Amcor Flexibles, Inc. |

accessory for use in the EOGas 4® Ethylene Oxide Gas Sterilization System manufactured by Andersen Sterilizers, Inc.

This 510(k) submission modifies the indications for use of the predicate device in order to include Tyvek Sterilization Pouches with Chevron Seal as an accessory for use in the Anprolene® AN75 Ethylene Oxide Sterilization System manufactured by Andersen Sterilizers, Inc. No modifications were made to the manufacturing method, technology, or intended use.

5.6 Device Description

Tyvek Sterilization Pouches with Chevron Seal are constructed from an uncoated Tyvek backing of fine, continuous, high-density polyethylene fibers, with front material consisting of a clear, laminated polyethylene terephthalate / low density polyethylene (LDPE) or LDPE-ethylenevinylacetate copolymer film. The pouches are used to enclose medical devices that are to be sterilized by a healthcare provider in the 12 hour sterilization cycle at 20-29°C in an Anprolene AN75 Ethylene Oxide Gas Sterilizer. Following manufacturer's instructions, devices are inserted into Tyvek Sterilization Pouches and sealed. The self-seal pouch permits sealing of the pouch without heat-sealing equipment, whereas the heat-sealable pouches must be heat sealed

5

prior to the cycle. Andersen Sterilizers' AN85/AN86 EO Indicators, when placed on the outside of the sterilization pouches, indicate EO exposure and offer a convenient way to differentiate pouches that have been processed in EO sterilization cycles from unprocessed units. The color of the AN85/AN86 EO Indicators changes from yellow-green to blue after exposure to EO. After completion of the sterilization process, the pouches maintain sterility of the enclosed medical devices for at least 3 months (90 days).

5.7 Indications for Use

Tyvek Sterilization Pouches with Chevron Seal are intended to enclose medical devices that are to be sterilized in a single pouch configuration at a healthcare facility. They are used in the 12 hour sterilization cycle at 20-29°C in the Anprolene AN75 Ethylene Oxide Gas Sterilizer. Critical process parameters for the cycle are summarized in Table 5-1.

Table 5-1. Critical parameters for the 12 hour cycle in the Anprolene AN75 Ethylene Oxide Gas Sterilizer

| Ethylene Oxide | Temperature | Relative
Humidity | Ethylene Oxide
Exposure Time | Total Cycle Time |
|----------------|-------------|----------------------|---------------------------------|------------------|
| 17.6 g ± 5% | 20-29°C | 35-90% | 12 hours | 14 hours |

The product codes for Tyvek Sterilization Pouches are listed in Table 5-2.

Table 5-2. Product codes for Tyvek Sterilization Pouches
----------------------------------------------------------
Product TypeSelf-Seal, Heat Seal, Tubing
Product CodesTLP-030, TLP-031, TLP-033, TLP-058, TLP-059

The 12 hour cycle in the Anprolene AN75 Ethylene Oxide Gas Sterilizer has been validated to sterilize a load of up to 24 lbs of metal surgical instruments, 3 lbs of fabric, or 3.5 lbs of plastic devices (combined weight of pouched devices and tray). Sterility was maintained for at least 3 months after processing in an Anprolene AN75 sterilizer.

5.8 Device Comparison

The technological characteristics of Tyvek Sterilization Pouches with Chevron Seal are identical to the predicate device - both are intended for the same use, use the same technology, and are designed in the same way.

The subject Tyvek Sterilization Pouches with Chevron Seal differ from the predicate device only in the indicated sterilization cycle. The difference raises no issues related to safety or effectiveness of the subject device in the cycle. A comparison between the devices is listed in Table 5-3.

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| Table 5-3. Device Comparison
Elements | Predicate Device: Tyvek Sterilization
Pouches (K152058) | Subject Device: Tyvek Sterilization
Pouches (K170429) |
|------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended Use | To enclose medical devices, allow
sterilization of the enclosed devices, and
maintain sterility of the enclosed devices | Identical |
| Indications for
Use | Tyvek Sterilization Pouches with
Chevron Seal are intended to enclose
medical devices that are to be sterilized
in a single pouch configuration at a
healthcare facility. They are used in the
3 hour sterilization cycle at 50°C in the
EOGas 4 Ethylene Oxide Gas Sterilizer. | Tyvek Sterilization Pouches with
Chevron Seal are used to enclose
medical devices that are to be sterilized
in a single pouch configuration at a
healthcare facility. They are used in the
12 hour sterilization cycle at 20-29°C in
the Anprolene AN75 Ethylene Oxide
Gas Sterilizer. |
| Design | Adhesive laminated film is a clear, high
strength material;
Uncoated Tyvek is compatible with EO
sterilization, resistant to microbial
penetration, and resistant to puncture | Identical |
| Pouch Types | Self-seal pouch; Heat seal pouch; Heat
seal tubing | Identical |
| Device
Construction | Self-seal and heat seal pouches: front and
back materials are heat sealed together
on three sides; fourth side (end) remains
open for filling; end is sealed by heat
(heat seal pouches) or by removing
protective liner strip, folding along the
pre-fold, and pressing to the film (self-
seal pouches).
Heat seal tubing: front and back
materials are heat sealed together on two
sides; two ends are open for selecting
size and filling; ends are sealed by heat. | Identical |
| Materials | Clear laminated PET/LDPE or LDPE-
EVA film (front) and uncoated HDPE
Tyvek (back) | Identical |
| Configuration | Single pouch configuration | Identical |
| Shelf Life | 5 years from date of manufacture | Identical |
| Biocompatibility | Materials and biological evaluations
(Agar Diffusion Test, Cytotoxicity Test)
meet ISO 11607-1 requirements | Identical |
| Maintenance of
Sterility | Sterility is maintained for at least 3
months after processing in an EOGas 4
sterilizer | Sterility is maintained for at least 3
months after processing in an Anprolene
AN75 sterilizer |
| Aeration Time | ≥ 6 hours | No additional time other than the 2 hr
mandatory ventilation |
| Package
Integrity | Seal strength, microbial barrier, burst,
and peel open characteristics meet ISO
and ASTM requirements | Identical |

Table 5-3. Device Comparison

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5.9 Performance Testing

Performance testing was conducted to demonstrate that Tyvek Sterilization Pouches with Chevron Seal perform as intended to allow sterilization of the enclosed medical devices. Sterilization efficacy testing demonstrated a 12-Log reduction and a sterility assurance level of 10-6 using the half dose validation method under worst-case conditions. Tyvek Sterilization Pouches with Chevron Seal also maintain sterility of the enclosed devices as intended. Shelf life studies demonstrated after completion of the Anprolene AN75 sterilization process, sterility is maintained for at least 3 months. The performance of Tyvek Sterilization pouches is summarized in Table 5-4.

Table 5-4. Summary of bench tests performed to demonstrate safety and effectiveness of Tyvek
Sterilization Pouches
TestDescriptionResults
Compliance to ISO 11607-1
Package
IntegritySeal strength performance characteristics were maintained for
the manufactured seal.
Microbial Barrier: the contents of pouches were sterile when
the processed pouches were subjected to the microbial aerosol
challenge test.
Burst: ability to withstand the internal pressurization was
maintained.
Peel open characteristics were maintained.Meet ISO and
ASTM
requirements
Material
CompatibilitySeal strength test, microbial barrier properties, burst test, and
peel open test were studied to demonstrate material
compatibility characteristics of the Tyvek
Sterilization PouchesPass
BiocompatibilityNot direct patient-contacting devices;
Materials are non-toxic, FDA compliant, and meet ISO 11607-
1 requirements;
Biological and residual evaluations meet acceptable criteria;
Provides reasonable assurance for safetyPass
Shelf LifePhysical properties and microbial barrier of the processed
Tyvek Pouches was verified at the end of shelf life of 5 years;
Stability demonstrates reasonable assurance for effectivenessPass
Performance in the Anprolene AN75 Cycle
Sterilant
PenetrationEO penetrated the pouch under worst-case half-dose
conditions or an extreme biological challenge scenario, and
inactivated 6-Log biological indicatorsAllow a SAL of
$10^{-6}$ for the
sterilization cycle
Maintenance of
Package
SterilitySterility was maintained for at least 3 months after processing
in an Anprolene AN75 sterilizer.Pass

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5.10 Conclusion

Based on the intended use, technological characteristics, performance data, and nonclinical tests performed, the subject Tyvek Sterilization Pouches with Chevron Seal, indicated for use in the Anprolene AN75 sterilization system, are substantially equivalent to the predicate devices, Tyvek Sterilization Pouches with Chevron Seal (K152058), indicated for use in the EOGas 4 sterilization system.