K Number
K172753
Device Name
VERIFY VH2O2 Indicator Tape
Manufacturer
Date Cleared
2018-02-09

(150 days)

Product Code
Regulation Number
880.2800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The VERIFY™ VH2O2 Indicator Tape is intended to secure items wrapped in synthetic wrap materials until used and to distinguish between processed and unprocessed units through a color change from the start color (pink) to peach, yellow or lighter. The VERIFY™ VH2O2 Indicator Tape is also intended to be used as an external process indicator when applied to synthetic wrap materials and/or Tyvek pouches. The tape may be used in the following sterilization cycles: - Non Lumen, Flexible, Lumen and Fast Non Lumen Cycles of the V-PRO 1, 1 Plus, maX, 60 and maX 2 Sterlizers - · Standard Cycle of the STERRAD® 100S Sterilizer - · Standard and Advanced Cycles of the STERRAD® NX Sterilizer - · Express, Flex Scope, Duo and Standard Cycles of the STERRAD® 100 NX Sterilizer
Device Description
The VERIFY VH2O2 Indicator Tape consists of a special coated crepe paper with diagonal lines of a chemical indicator specific for hydrogen peroxide sterilization. It meets the performance specifications for a Type 1 process indicator as defined in ANSI/AAMI/ISO 11140-1:2014. The VERIFY | VH2O2 Indicator Tape and its packaging are manufactured in the absence of lead, heavy metals, natural rubber latex and dry natural rubber.
More Information

Not Found

No
The device is a chemical indicator tape that changes color based on exposure to hydrogen peroxide sterilization. There is no mention of any computational or learning capabilities.

No.
The device is an indicator tape used to confirm sterilization processes, not to treat a disease or condition.

No.
Explanation: The device is a chemical indicator tape used to distinguish between processed and unprocessed units in sterilization cycles, indicating a successful sterilization process, rather than diagnosing a medical condition. It functions as a process indicator, not a diagnostic device.

No

The device is a physical indicator tape with a chemical coating, not a software program.

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

Here's why:

  • Intended Use: The intended use is to secure items for sterilization and to indicate whether a sterilization process has occurred through a color change. This is a process indicator for sterilization, not a diagnostic test performed on biological samples.
  • Device Description: The device is a tape with a chemical indicator that reacts to hydrogen peroxide sterilization. It is described as a "Type 1 process indicator" according to a standard related to sterilization indicators.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), diagnosing a disease or condition, or providing information about a patient's health status.

Therefore, the VERIFY™ VH2O2 Indicator Tape is a sterilization process indicator, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The VERIFY™ VH2O2 Indicator Tape is intended to secure items wrapped in synthetic wrap materials until used and to distinguish between processed and unprocessed units through a color change from the start color (pink) to peach, yellow or lighter. The VERIFY™ VH2O2 Indicator Tape is also intended to be used as an external process indicator when applied to synthetic wrap materials and/or Tyvek pouches.

The tape may be used in the following sterilization cycles:

  • Non Lumen, Flexible, Lumen and Fast Non Lumen Cycles of the V-PRO 1, 1 Plus, maX, 60 and maX 2 Sterlizers
  • · Standard Cycle of the STERRAD® 100S Sterilizer
  • · Standard and Advanced Cycles of the STERRAD® NX Sterilizer
  • · Express, Flex Scope, Duo and Standard Cycles of the STERRAD® 100 NX Sterilizer

Product codes

JOJ

Device Description

The VERIFY VH2O2 Indicator Tape consists of a special coated crepe paper with diagonal lines of a chemical indicator specific for hydrogen peroxide sterilization. It meets the performance specifications for a Type 1 process indicator as defined in ANSI/AAMI/ISO 11140-1:2014.

The VERIFY | VH2O2 Indicator Tape and its packaging are manufactured in the absence of lead, heavy metals, natural rubber latex and dry natural rubber.

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

Simulated Use Testing in Fast Non Lumen Cycle: Result - Pass
Stability Testing for 18 month Shelf Life: Result - Pass

Key Metrics

Not Found

Predicate Device(s)

K160485

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.2800 Sterilization process indicator.

(a)
Biological sterilization process indicator —(1)Identification. A biological sterilization process indicator is a device intended for use by a health care provider to accompany products being sterilized through a sterilization procedure and to monitor adequacy of sterilization. The device consists of a known number of microorganisms, of known resistance to the mode of sterilization, in or on a carrier and enclosed in a protective package. Subsequent growth or failure of the microorganisms to grow under suitable conditions indicates the adequacy of sterilization.(2)
Classification. Class II (performance standards).(b)
Physical/chemical sterilization process indicator —(1)Identification. A physical/chemical sterilization process indicator is a device intended for use by a health care provider to accompany products being sterilized through a sterilization procedure and to monitor one or more parameters of the sterilization process. The adequacy of the sterilization conditions as measured by these parameters is indicated by a visible change in the device.(2)
Classification. Class II (performance standards).

0

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February 9, 2018

Steris Corporation Bill Brodbeck Director, Regulatory Affairs 5960 Heisley Road Mentor, Ohio 44060

Re: K172753

Trade/Device Name: VERIFY VH2O2 Indicator Tape Regulation Number: 21 CFR 880.2800 Regulation Name: Sterilization Process Indicator Regulatory Class: Class II Product Code: JOJ Dated: January 9, 2017 Received: January 10, 2018

Dear Bill Brodbeck:

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);

1

and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

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

Indications for Use

510(k) Number (if known) K172753

Device Name VERIFY VH2O2 Indicator Tape

Indications for Use (Describe)

The VERIFY™ VH2O2 Indicator Tape is intended to secure items wrapped in synthetic wrap materials until used and to distinguish between processed and unprocessed units through a color change from the start color (pink) to peach, yellow or lighter. The VERIFY™ VH2O2 Indicator Tape is also intended to be used as an external process indicator when applied to synthetic wrap materials and/or Tyvek pouches.

The tape may be used in the following sterilization cycles:

  • Non Lumen, Flexible, Lumen and Fast Non Lumen Cycles of the V-PRO 1, 1 Plus, maX, 60 and maX 2 Sterlizers
  • · Standard Cycle of the STERRAD® 100S Sterilizer
  • · Standard and Advanced Cycles of the STERRAD® NX Sterilizer
  • · Express, Flex Scope, Duo and Standard Cycles of the STERRAD® 100 NX 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)

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STERIS®

Image /page/3/Picture/2 description: The image shows a blue graphic of six horizontal lines that are curved. The lines are stacked on top of each other, with the top line having the smallest curve and the bottom line having the largest curve. The lines are all the same thickness and color, and they are evenly spaced apart.

510(k) Summary for VERIFY™ VH2O2 Indicator Tape K172753

STERIS Corporation 5960 Heisley Road Mentor, OH 44060 Phone: (216) 354-2600 Fax No: (216) 639-4459

Contact: Bill Brodbeck Director, Regulatory Affairs Telephone: (440) 392-7690 Fax No: (440) 357-9198 E-mail: William_brodbeck@steris.com

Submission Date: September 11, 2017

STERIS Corporation ■ 5960 Heisley Road ■ Mentor, OH 44060-1834 USA ■ 440-354-2600

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TRADITIONAL PREMARKET NOTIFICATION [510(k)] VERIFYTM VH2O2 Indicator Tape

Device Name 1.

Trade Name:VERIFY™ VH2O2 Indicator Tape
Common/Usual Name:Chemical Sterilization Process Indicator
Classification Name:Sterilization Process Indicator
(21 CFR 880.2800, JOJ)
Classification:Class II

Predicate Device 2.

VERIFYTM VH2O2 Indicator Tape (K160485)

3. Description of Device

The VERIFY VH2O2 Indicator Tape consists of a special coated crepe paper with diagonal lines of a chemical indicator specific for hydrogen peroxide sterilization. It meets the performance specifications for a Type 1 process indicator as defined in ANSI/AAMI/ISO 11140-1:2014.

The VERIFY | VH2O2 Indicator Tape and its packaging are manufactured in the absence of lead, heavy metals, natural rubber latex and dry natural rubber.

Intended Use/ Indications for Use 4.

The VERIFY™ VH2O2 Indicator Tape is intended to secure items wrapped in synthetic wrap materials until used and to distinguish between processed and unprocessed units through a color change from the start color (pink) to peach, yellow or lighter. The VERIFY™ VH2O2 Indicator Tape is also intended to be used as an external process indicator when applied to synthetic wrap materials and/or Tyvek pouches.

The tape may be used in the following sterilization cycles:

  • Non Lumen, Flexible, Lumen and Fast Non Lumen Cycles of the V-PRO 1, 1 . Plus, maX, 60 and maX 2 Sterilizers
  • Standard Cycle of the STERRAD® 100S Sterilizer ●
  • Standard and Advanced Cycles of the STERRAD® NX Sterilizer ●
  • Express, Flex Scope, Duo and Standard Cycles of the STERRAD® 100 NX Sterilizer

5

TRADITIONAL PREMARKET NOTIFICATION [510(k)] VERIFY™ VH2O2 Indicator Tape

Table 5.1 Indications for Use Comparison
ProposedPredicate (K160485)Comparison
VERIFY VH2O2 Indicator TapeVERIFY VH2O2 Indicator Tape
The VERIFYTM VH2O2 Indicator
Tape is intended to secure items
wrapped in synthetic wrap materials
until used and to distinguish
between processed and unprocessed
units through a color change from
the start color (pink) to peach,
yellow or lighter. The VERIFYTM
VH2O2 Indicator Tape is also
intended to be used as an external
process indicator when applied to
synthetic wrap materials and/or
Tyvek pouches.

The tape may be used in the
following sterilization cycles:
Non Lumen, Flexible, Lumen
and Fast Non Lumen Cycles of
the V-PRO 1, 1 Plus, maX, 60
and maX 2 Sterilizers Standard Cycle of the
STERRAD® 100S Sterilizer Standard and Advanced Cycles
of the STERRAD® NX
Sterilizer Express, Flex Scope, Duo and
Standard Cycles of the
STERRAD® 100 NX Sterilizer | The VERIFY VH2O2 Indicator Tape is
intended to secure items wrapped in
synthetic wrap materials until used and
to distinguish between processed and
unprocessed units through a color
change from the start color (pink) to
peach, yellow or lighter.

The tape may be used in the following
sterilization cycles:
Non Lumen, Flexible and Lumen
Cycles of the V-PRO 1, 1 Plus, maX
and 60 Low Temperature Sterilizers Standard Cycle of the STERRAD®
100S Sterilizer Standard and Advanced Cycles of the
STERRAD® NX Sterilizer Express,
Flex Scope, Duo and Standard
Cycles of the STERRAD® 100 NX
Sterilizer | The Indications for
Use has been
modified in the
proposed device in
order to include the
Fast Non Lumen
Cycle of the V-PRO
maX 2 device.

The proposed device
also includes the
statement that the
VERIFYTM VH2O2
Indicator Tape is
also intended to be
used as an external
process indicator
when applied to
synthetic wrap
materials and/or
Tyvek pouches. |

5. Description of Safety and Substantial Equivalence

The VERIFY VH2O2 Indicator Tape has equivalent characteristics as compared to its predicate device. Table 5.2 compares the proposed device's design to the predicate.

CharacteristicProposedPredicateComparison
SubstrateCrepe PaperCrepe PaperSame
IndicatorProprietary -
conforms
with ISO
11140-
1:2014 Type
1 requirementsProprietary -
conforms with ISO
11140-1:2014 Type
1 requirementsSame
AdhesiveProprietaryProprietaryTesting included in this
submission
demonstrating

Table 5.2 Device Comparison

6

TRADITIONAL PREMARKET NOTIFICATION [510(k)]
VERIFY™ VH2O2 Indicator Tape
CharacteristicProposedPredicateComparison
performance (See Table
5.3).
Color ChangePink to
Peach/YellowPink to
Peach/YellowSame
Detectionhydrogen
peroxide dosehydrogen peroxide
doseSame
Shelf-life18 months18 monthsSame
Storage Conditions16 - 24°C,
30 - 60% RH16 - 24°C
30 - 60% RHTesting included in this
submission to support
proposed device's shelf
life when stored under
labeled conditions (See
Table 5.3).

Since the VERIFY | VH2O2 Indicator Tape is identical to the predicate device, prior nonclinical testing (K160485) is referenced in this submission to support performance of the chemical indicator in accordance to the vapor-phased hydrogen peroxide, Type 1 chemical indicator requirements in ANSI/AAMI/ISO 11140-1:2014. Furthermore, since the proposed device is identical to the proposed device, testing was provided in K160485 addresses endpoint stability, light stability, biocompatibility and adhesion. To demonstrate that the CI performs appropriately according to the proposed device's expanded claims, performance was tested in the V-PRO maX 2's Fast Non Lumen Cycle with loads under simulated use conditions under pass and fail conditions. Shelf-life testing evaluated CI performance per ANSI/AAMI/ISO 11140-1:2014, endpoint color stability and tape adhesion after various times of storage within the labeled storage conditions. Table 5.3 summarizes the testing performed in the current submission.

Table 5.3 Summary of Nonclinical Tests:

TestResult
Simulated Use Testing in Fast Non Lumen CyclePass
Stability Testing for 18 month Shelf LifePass

6. Conclusion

Based on the intended uses, technological characteristics and non-clinical performance data, the subject device is as safe, as effective and perform at least as well as the legally marketed predicate device K160485, Class II (21 CFR 880.2800), product code JOJ.