K Number
K200334
Device Name
AN1036 Dosimeter
Date Cleared
2020-11-12

(275 days)

Product Code
Regulation Number
880.2800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
AN1036 Dosimeter is a single-use color change chemical indicator. It is calibrated for sterilization temperature and used to verify adequate cumulative ethylene oxide exposure in a 3-hour or 6-hour gas exposure at 50°C in the EOGas 4 Ethylene Oxide Gas Sterilizer manufactured by Andersen Sterilizers, Inc.
Device Description
The AN1036 Dosimeter is a single-use chemical indicator for cumulative ethylene oxide exposure. It is an accessory for the EOGas 4 Ethylene Oxide Gas Sterilizer. The AN1036 Dosimeter contains a proprietary pH indicator in a glass capillary tube that is sealed on one end and mounted on a plastic tray. It is calibrated for a 50℃ sterilization temperature and responds to ethylene oxide concentration and sterilization time. With exposure to ethylene oxide, the indicator turns from yellow-orange to a dark blue color from the open end toward the closed end. The extent of the color change is proportional to cumulative ethylene oxide exposure. The cycle-specific calibration marks represent adequate cumulative ethylene oxide exposure to inactivate a 6-Log Bacillus atrophaeus biological indicator at the location of the AN1036 Dosimeter after 3-hour gas exposures or at the center of the endoscope lumens after 6-hour gas exposures. The AN1036 Dosimeter is not a replacement for a biological indicator.
More Information

Not Found

No
The device is a chemical indicator that changes color based on chemical exposure, not through computational analysis or learning.

No.
The device is a chemical indicator used to verify adequate ethylene oxide exposure in a sterilizer, not to treat a medical condition or ailment.

No

The device is a chemical indicator used to verify adequate cumulative ethylene oxide exposure in a sterilizer. It is an accessory to a sterilizer, not a diagnostic device for medical conditions.

No

The device is a physical chemical indicator that changes color based on exposure to ethylene oxide, not a software program.

Based on the provided information, the AN1036 Dosimeter is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use is to verify adequate cumulative ethylene oxide exposure during a sterilization process. This is a quality control measure for a sterilization cycle, not a test performed on a biological sample from a human or animal to diagnose a condition, monitor treatment, or screen for disease.
  • Device Description: The device is a chemical indicator that changes color based on exposure to ethylene oxide. It is an accessory to a sterilizer. It does not interact with biological samples.
  • Lack of Biological Sample Testing: The description does not mention any testing of biological samples (blood, urine, tissue, etc.).
  • Performance Studies: The performance studies focus on the device's response to sterilization parameters (temperature, time, ethylene oxide concentration) and its ability to indicate adequate sterilization conditions, not on its ability to detect or measure substances in biological samples.

IVD devices are specifically designed to be used in vitro (outside the body) to examine specimens derived from the human body to provide information for diagnostic, monitoring, or screening purposes. The AN1036 Dosimeter does not fit this definition.

N/A

Intended Use / Indications for Use

AN1036 Dosimeter is a single-use color change chemical indicator. It is calibrated for sterilization temperature and used to verify adequate cumulative ethylene oxide exposure in a 3-hour or 6-hour gas exposure at 50°C in the EOGas 4 Ethylene Oxide Gas Sterilizer manufactured by Andersen Sterilizers, Inc.

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

JOJ

Device Description

The AN1036 Dosimeter is a single-use chemical indicator for cumulative ethylene oxide exposure. It is an accessory for the EOGas 4 Ethylene Oxide Gas Sterilizer.

The AN1036 Dosimeter contains a proprietary pH indicator in a glass capillary tube that is sealed on one end and mounted on a plastic tray. It is calibrated for a 50℃ sterilization temperature and responds to ethylene oxide concentration and sterilization time. With exposure to ethylene oxide, the indicator turns from yellow-orange to a dark blue color from the open end toward the closed end. The extent of the color change is proportional to cumulative ethylene oxide exposure. The cycle-specific calibration marks represent adequate cumulative ethylene oxide exposure to inactivate a 6-Log Bacillus atrophaeus biological indicator at the location of the AN1036 Dosimeter after 3-hour gas exposures or at the center of the endoscope lumens after 6-hour gas exposures. The AN1036 Dosimeter is not a replacement for a biological indicator.

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)

The AN1036 Dosimeters were validated using applicable tests in:

    1. FDA 2003 guideline, "Premarket Notification [510(k)] Submissions for Chemical Indicators: Guidance for Industry and FDA Staff"; and
    1. ANSI AAMI ISO 11140-1, "Sterilization of health care products Chemical Indicators -Part 1: General requirements" (FDA Recognition Number 14-460).

The performance of the AN1036 Dosimeter was characterized in an Andersen Chemical Indicator Evaluator Resistometer as well as in the EOGas 4 Ethylene Oxide Gas Sterilizer using 3- and 6-hour gas exposures at 50°C. The critical parameters to which the AN1036 responds include temperature, time, and ethylene oxide gas concentration in a relative humidity-controlled environment. The AN1036 indicates adequate cumulative EO exposure in the cycle for all validated loads in the EOGas 4 Ethylene Oxide Gas Sterilizer. Using the AN1036 Dosimeter at various stages of shelf life, the distance the blue line travels is stable for a minimum of 28 days after the sterilization cycle when AN1036 Dosimeters are stored at room temperature (20-25°C) and 4 days when stored at 50°C. Real-time shelf life testing with the AN1036 Dosimeter supports a shelf life of 3 years.

Results from tests:

  • Chemical Indicator: AN1036 Dosimeters respond to EO concentration, sterilization time, and temperature, at a relative humidity of 35-90%. AN1036 Dosimeters correctly indicate pass/fail in various endoscope loads. A correlation exists between the extent the blue color travels and cumulative EO exposure.
  • Biocompatibility: AN1036 Dosimeter is not a direct or indirect patient-contacting device. None of the major ingredients is hazardous. No chemicals leach out of the AN1036 Dosimeters during the sterilization cycle. Without any additional aeration, the residual EO detected in Dosimeters met ISO 10993-7 requirements.
  • Endpoint Color Stability: Endpoint blue color is stable for 28 days at 20-25°C or 4 days at 50°C after 6-hour gas exposures.
  • Shelf Life: Data supports claimed shelf life of 3 years.

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.

K150645

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

§ 880.2800 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

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

November 12, 2020

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

Re: K200334

Trade/Device Name: AN1036 Dosimeter Regulation Number: 21 CFR 880.2800 Regulation Name: Sterilization Process Indicator Regulatory Class: Class II Product Code: JOJ Dated: October 26, 2020 Received: October 29, 2020

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4. Subpart A) for combination products; 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

CAPT Elizabeth Claverie, MS Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2020 See PRA Statement below.

510(k) Number (if known) K200334

Device Name AN1036 Dosimeter

Indications for Use (Describe)

AN 1036 Dosimeter is a single-use color change chemical indicator. It is calibrated for sterilization temperature and used to verify adequate cumulative ethylene oxide exposure in a 3-hour gas exposure at 50°C in the EOGas 4 Ethylene Oxide Gas Sterilizer manufactured by Andersen Sterilizers, Inc.

Critical process parameters for the cycles are summarized in Table 1.

Table 1. Critical sterilization cycle parameters in the EOGas 4 Ethylene Oxide Gas Sterilizer

Ethylene OxideTemperatureRelative HumidityEO Exposure TimeTotal Cycle Time
17.6 g ± 5%50°C ± 3°C35-70%3 hours3.5 hours
6 hours7 hours

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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3

510(k) Summary K200334

Applicant's Name and Address

Andersen Sterilizers, Inc. Establishment Registration Number 3004634710 3154 Caroline Drive Haw River, NC 27258

Contact Person

William K. Andersen, BE, MD, FAAOS President Phone: 336-376-8622; Fax: 336-376-5428

Date of Preparation

October 26, 2020

Device

Proprietary Name AN1036 Dosimeter Common Name Indicator, Physical/Chemical Sterilization Process Classification Class II (21 CFR 880.2800) Chemical Indicator Product Code 101

The refill kits for the EOGas 4 Ethylene Oxide Gas Sterilizer, including the accessories (sterilization bags, EOGas 4 cartridges, Dosimeters, and Humidichips), are registered with the US Environmental Protection Agency (EPA #69340-7).

Predicate Device

Device NameAN1087 Dosimeter
510(k) numberK150645
ManufacturerAndersen Sterilizers, Inc.

The predicate AN1087 Dosimeters were cleared for use with 3-hour gas exposures in the EOGas 4 Ethylene Oxide Gas Sterilization system manufactured by Andersen Sterilizers, Inc.

The sterilization time claim of the predicate device was modified in order to indicate the AN1087 Dosimeters for use in 6-hour gas exposures in the EOGas 4 Ethylene Oxide Gas Sterilization System. No modifications were made to the manufacturing method, technology, or intended use.

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Device Description

The AN1036 Dosimeter is a single-use chemical indicator for cumulative ethylene oxide exposure. It is an accessory for the EOGas 4 Ethylene Oxide Gas Sterilizer.

The AN1036 Dosimeter contains a proprietary pH indicator in a glass capillary tube that is sealed on one end and mounted on a plastic tray. It is calibrated for a 50℃ sterilization temperature and responds to ethylene oxide concentration and sterilization time. With exposure to ethylene oxide, the indicator turns from yellow-orange to a dark blue color from the open end toward the closed end. The extent of the color change is proportional to cumulative ethylene oxide exposure. The cycle-specific calibration marks represent adequate cumulative ethylene oxide exposure to inactivate a 6-Log Bacillus atrophaeus biological indicator at the location of the AN1036 Dosimeter after 3-hour gas exposures or at the center of the endoscope lumens after 6-hour gas exposures. The AN1036 Dosimeter is not a replacement for a biological indicator.

Indications for Use

AN1036 Dosimeter is a single-use color change chemical indicator. It is calibrated for sterilization temperature and used to verify adequate cumulative ethylene oxide exposure in a 3-hour or 6-hour gas exposure at 50°C in the EOGas 4 Ethylene Oxide Gas Sterilizer manufactured by Andersen Sterilizers, Inc.

Critical process parameters for the cycles are summarized in Table 5-1.

| Ethylene Oxide | Temperature | Relative
Humidity | Ethylene Oxide
Exposure Time | Total Cycle Time |
|----------------|-------------|----------------------|---------------------------------|------------------|
| 17.6 g ± 5% | 50°C ± 3°C | 35-90% | 3 hours | 3.5 hours |
| | | | 6 hours | 7 hours |

Table 5-1. Critical sterilization cycle parameters in the EOGas 4 Ethylene Oxide Gas Sterilizer

Technological Characteristics Comparison

The subject AN1036 Dosimeter is compared to the predicate AN1087 Dosimeter (K150645): there is no difference in intended use, design principles, technical characteristics, or performance between the devices.

The difference between the predicate AN1087 and subject AN1036 Dosimeters is the addition of a calibration mark suitable for a 6-hour gas exposure.

A comparison between the indicators is listed in Table 5-2.

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| | Predicate AN1087 Dosimeter
(K150645) | Subject AN1036 Dosimeter
(K200334) | Comparison |
|----------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|
| Intended Use | Chemical indicator for
cumulative EO exposure in the
EOGas 4 Ethylene Oxide Gas
Sterilizer | Chemical indicator for
cumulative EO exposure in the
EOGas 4 Ethylene Oxide Gas
Sterilizer | Identical |
| Design | A pH indicator changes color
when exposed to EO;
The extent of the color changes
is proportional to cumulative
EO exposure;
Calibrated for use at 50±3°C;
One calibration mark for use in
3-hour gas exposures | A pH indicator changes color
when exposed to EO;
The extent of the color
changes is proportional to
cumulative EO exposure;
Calibrated for use at 50±3°C;
Two calibration marks for use
in both 3-hour and 6-hour gas
exposures | Identical |
| Technology | Chemical reactions with EO
change the pH, and therefore
the color, of the indicator ink | Chemical reactions with EO
change the pH, and therefore
the color, of the indicator ink | Identical |
| Performance | Indicates cumulative EO
exposure | Indicates cumulative EO
exposure | Identical |
| Shelf Life | 3 years | 3 years | Identical |
| Endpoint
Specifications | Endpoint blue color is stable
for 28 days at 20-25°C and 3
days at 50°C. | Endpoint blue color is stable
for 28 days at 20-25°C and 4
days at 50°C. | Similar |

Table 5-2. Comparison between the subject AN1036 Dosimeter and the predicate AN1087 Dosimeter (K150645)

Summary of Non-clinical Testing:

The AN1036 Dosimeters were validated using applicable tests in:

    1. FDA 2003 guideline, "Premarket Notification [510(k)] Submissions for Chemical Indicators: Guidance for Industry and FDA Staff"; and
    1. ANSI AAMI ISO 11140-1, "Sterilization of health care products Chemical Indicators -Part 1: General requirements" (FDA Recognition Number 14-460).

The performance of the AN1036 Dosimeter was characterized in an Andersen Chemical Indicator Evaluator Resistometer as well as in the EOGas 4 Ethylene Oxide Gas Sterilizer using 3- and 6-hour gas exposures at 50°C. The critical parameters to which the AN1036 responds include temperature, time, and ethylene oxide gas concentration in a relative humidity-controlled environment. The AN1036 indicates adequate cumulative EO exposure in the cycle for all validated loads in the EOGas 4 Ethylene Oxide Gas Sterilizer. Using the AN1036 Dosimeter at various stages of shelf life, the distance the blue line travels is stable for a minimum of 28 days after the sterilization cycle when AN1036 Dosimeters are stored at room temperature (20-25°C) and 4 days when stored at 50°C. Real-time shelf life testing with the AN1036 Dosimeter supports a shelf life of 3 years.

6

Performance testing is summarized in Table 5-3.

TestPurposeAcceptance CriteriaResults
Chemical
IndicatorTo validate AN1036
Dosimeter as a
chemical indicator per
ANSI/AAMI/ISO
11140-1 and FDA
Chemical Indicator
guidanceCritical parameters
with pass/fail criteria;
Able to correctly
indicate pass/fail
results from the EOGas
4 SterilizerAN1036 Dosimeters respond to
EO concentration, sterilization
time, and temperature, at a
relative humidity of 35-90%.
AN1036 Dosimeters correctly
indicate pass/fail in various
endoscope loads.
A correlation exists between the
extent the blue color travels and
cumulative EO exposure.
BiocompatibilityTo demonstrate the
AN1036 Dosimeters
are safe to useProvides reasonable
assurance for safetyAN1036 Dosimeter is not a direct
or indirect patient-contacting
device.
None of the major ingredients is
hazardous.
No chemicals leach out of the
AN1036 Dosimeters during the
sterilization cycle.
Without any additional aeration,
the residual EO detected in
Dosimeters met ISO 10993-7
requirements.
Endpoint Color
StabilityTo evaluate the
stability of the
endpoint colorStability demonstrates
reasonable assurance
for effectivenessEndpoint blue color is stable for
28 days at 20-25°C or 4 days at
50°C after 6-hour gas exposures.
Shelf LifeEvaluate the ability to
correctly indicate
pass/fail in cycles
through the shelf lifeMaintains performance
specifications
throughout the stated
shelf lifeData supports claimed shelf life
of 3 years

Table 5-3. Summary of bench tests performed to demonstrate safety and effectiveness of the AN1036 Dosimeter

Conclusions:

The conclusions drawn from the nonclinical tests demonstrate that the AN1036 Dosimeter device is as safe, as effective, and performs as well as or better than the legally marketed AN1087 Dosimeter (K150645).