K Number
K202513
Date Cleared
2021-04-09

(221 days)

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

The Disposable Medical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. These masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use ,disposable device, provided non-sterile.

Device Description

The proposed devices are single use, three-layer, flat masks with straps and nose piece. The Disposable Medical Face Masks are manufactured with three layers, the inner and outer layers are made of spun-bond polypropylene, and the middle layer is made of melt blown polypropylene filter. The proposed device is held in place over the user's mouth and nose by two elastic ear loops welded to the face mask. The elastic ear loops are not made with natural rubber latex. The nose piece contained in the proposed device is in the layers of face mask to allow the user to fit the face mask around their nose, which is made of polyethylene with steel wire. The proposed devices are sold non-sterile and are intended to be single use. disposable devices.

AI/ML Overview

The provided document is a 510(k) Premarket Notification for a Disposable Medical Face Mask (Model FM-04). This type of submission is for medical devices and focuses on demonstrating substantial equivalence to a legally marketed predicate device, rather than a full study proving a device meets strict acceptance criteria in a clinical setting in the way an AI/Software as a Medical Device (SaMD) study would.

Therefore, many of the requested categories (e.g., sample size for test set, number of experts for ground truth, adjudication methods, MRMC studies, standalone algorithm performance, training set sample size, how ground truth for training set was established) are not applicable to this type of medical device submission.

The "acceptance criteria" and "reported device performance" here refer to non-clinical performance and safety testing against established standards for medical face masks.

Here's the information extracted from the document relevant to your request:

1. Table of Acceptance Criteria and Reported Device Performance

ItemsAcceptance CriteriaReported Device Performance
Fluid Resistance Performance (ASTM F1862)29 out of 32 pass at 120 mmHg32 out of 32 pass at 120 mmHg
Particulate Filtration Efficiency (ASTM F2299)≥ 98%99.8%
Bacterial Filtration Efficiency (ASTM F2101)≥ 98%99.9%
Differential Pressure (EN 14683:2019)

§ 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.