K Number
K222999
Device Name
Surgical Gown
Date Cleared
2023-06-16

(261 days)

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

Surgical Gowns are intended to be worn by operating room personnel during surgical procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate material. This surgical gown meets the requrements of AAMI Level 3 barrier protection for a surgical gown per ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities (AAMI PB70). The Surgical Gowns are single use, disposable medical devices; provided non-sterile. Before the use, the Surgical Gowns must be sterilized by EO sterilization based on ISO 11135:2014.

Device Description

The Surgical Gown is composed of collar, body, sleeve and tie, in a blue color, offered in sizes S, M, L, XL and XXL. The neck and waist are laced, the sleeves are made of polyester elastic closure by sewing, and the rest are made of heat sealing. It has been tested according to AAMI PB70:2012 and meet AAMI Level 3 barrier level protection for a surgical gown.

AI/ML Overview

Here's a summary of the acceptance criteria and the study that proves the device meets them, based on the provided text:

Device: Surgical Gown (K222999)

1. Table of Acceptance Criteria and Reported Device Performance:

Test MethodologyPurposeAcceptance CriteriaReported Device Performance
AATCC 42Impact PenetrationLevel 3, ≤1.0g<1.0g
AATCC 127Hydrostatic ResistanceLevel 3, ≥50cm≥50cm
ASTM D5034Tensile strengthMachine direction mean: ≥18 lbf; Cross direction mean: ≥12 lbfMachine direction mean ≥32.9 lbf; Cross direction mean ≥26.3 lbf
ASTM D5587Tear resistanceFabric direction A mean: ≥4.0 lbf; Fabric direction B mean: ≥2.5 lbfMachine direction mean ≥9.3 lbf; Cross direction mean ≥18.2 lbf
ASTM D1683Seam strengthShoulder: ≥8.5 lbf; Arm opening: ≥5.5 lbf; Sleeve: ≥8.5 lbfShoulder: ≥10.1 lbf; Arm opening: ≥7.2 lbf; Sleeve: ≥10.1 lbf
ASTM F1868Evaporative Resistance of fabricsMean Evaporative Resistance (Ref) ≥0.06 (kPa·m²/W)Mean Evaporative Resistance (Ref) ≥0.06 (kPa·m²/W)
ISO 9073-10Lint and Other particles generation in the dry stateLog10 < 4Index for Particulate Matter (IPM) < 2.89
16 CFR Part 1610Flammability testingClass 1, Non FlammableClass 1, Non Flammable
CytotoxicityBiocompatibility - cytotoxicityNo potential cytotoxicityNo potential cytotoxicity
IrritationBiocompatibility - irritationNo irritationNo irritation
SensitizationBiocompatibility - sensitizationNo sensitizationNo sensitization
Acute systemic toxicityBiocompatibility - Acute systemic toxicityNo acute systemic toxicity in vivoNo acute systemic toxicity in vivo
Ethylene oxide residuesEthylene oxide sterilization residualsEO ≤ 4mg/device; ECH ≤ 9mg/deviceEO: 3.68 mg/device; ECH: 0.94 mg/device

The reported device performance for all criteria met or exceeded the acceptance criteria.

2. Sample Size Used for the Test Set and Data Provenance:

The document does not explicitly state the specific sample sizes used for each individual test (e.g., how many gowns were tested for impact penetration). It only states that the device "was tested and conformed to the related recognized standards." The provenance of the data is implied to be from testing conducted by or for Hubei Woozon Healthcare Co.,Ltd. The document does not specify the country of origin of the data or whether the tests were retrospective or prospective, beyond stating that they were non-clinical tests.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts:

Not applicable. This device is a surgical gown, and its performance is evaluated through standardized physical, chemical, and biological barrier tests, not through expert human interpretation of medical images or data requiring ground truth establishment by medical experts.

4. Adjudication Method for the Test Set:

Not applicable. As described above, the evaluation relies on adherence to standardized test methods and their defined pass/fail criteria, rather than expert adjudication.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and Effect Size:

No. This type of study is not relevant for the evaluation of a surgical gown. MRMC studies are typically conducted for AI/CAD systems that assist human readers in interpreting medical images.

6. If a Standalone (Algorithm Only Without Human-in-the-Loop Performance) Was Done:

Not applicable. The "device" in this context is a physical product (surgical gown), not an algorithm or AI system. Its performance is inherent to the product itself, not an algorithmic output.

7. The Type of Ground Truth Used:

The "ground truth" for the surgical gown is established by the specified performance requirements and limitations outlined in the recognized standards (e.g., AAMI PB70, AATCC, ASTM, ISO, 16 CFR). These standards define the acceptable levels of barrier protection, strength, flammability, and biocompatibility. The results of the tests conducted directly against these standards serve as the evidence that the device meets the "ground truth" requirements.

8. The Sample Size for the Training Set:

Not applicable. This device is a manufactured product, not an AI/machine learning model that requires a training set.

9. How the Ground Truth for the Training Set Was Established:

Not applicable, for the same reason as point 8.

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Image /page/0/Picture/0 description: The image shows 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, with the letters "FDA" in a blue square. Next to that is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

June 16, 2023

Hubei Woozon Healthcare Co.,Ltd. % Boyle Wang General Manager Shanghai Truthful Information Technology Co., Ltd RM.1801,No.161 Lujiazui East Rd.,Pudong Shanghai, Shanghai 200120 China

Re: K222999

Trade/Device Name: Surgical Gown Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FYA Dated: May 10, 2023 Received: May 22, 2023

Dear Boyle Wang:

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

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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) 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,

Bifeng Qian -S

Bifeng Qian, MD, Ph.D. 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

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Indications for Use

510(k) Number (if known) K222999

Device Name Surgical Gown

Indications for Use (Describe)

Surgical Gowns are intended to be worn by operating room personnel during surgical procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate material. This surgical gown meets the requrements of AAMI Level 3 barrier protection for a surgical gown per ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities (AAMI PB70). The Surgical Gowns are single use, disposable medical devices; provided non-sterile. Before the use, the Surgical Gowns must be sterilized by EO sterilization based on ISO 11135:2014.

Type of Use ( Select one or both, as applicable )
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| Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary K222999

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and 21 CFR 807.92.

1.0 Submitter's information

Name: Hubei Woozon Healthcare Co.,Ltd. Address: Nongfeng Road, Nonwoven Fabric Industrial Park, Wangzhou Avenue, Pengchang Town, Xiantao City, Hubei, China. Contact: Li Chunlin Phone Number: 86-728-3280667 Fax number: 86-728-3280667 Date of Preparation: June 12, 2023

Designated Submission Correspondent

Contact: Mr. Boyle Wang Address: Shanghai Truthful Information Technology Co., Ltd. Room 1801, No. 161 Lujiazui East Rd., Pudong Shanghai, 200120 China Tel: +86-21-50313932 Email: Info@truthful.com.cn

2.0 Device information

Trade name:Surgical Gown
Common name:Surgical gown
Classification name:Gown, Surgical
Model(s):S, M, L, XL, XXL

3.0 Classification

Production code:FYA - Gown, Surgical
Regulation number:21CFR 878.4040 - Surgical apparel
Classification:Class II
Panel:Surgical apparel

4.0 Predicate device information

Manufacturer: Hubei Wanli Protective Products Co. Ltd

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Surgical Gown Device: K211509 510(k) number:

5.0 Intended Use/Indication for Use Statement

Surgical Gowns are intended to be worn by operating room personnel during surgical procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate material. This surgical gown meets the requirements of AAMI Level 3 barrier protection for a surgical gown per ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities (AAMI PB70). The Surgical Gowns are single use, disposable medical devices; provided non-sterile. Before the use, the Surgical Gowns must be sterilized by EO sterilization based on ISO 11135:2014.

6.0 Device description

The Surgical Gown is composed of collar, body, sleeve and tie, in a blue color, offered in sizes S, M, L, XL and XXL. The neck and waist are laced, the sleeves are made of polyester elastic closure by sewing, and the rest are made of heat sealing. It has been tested according to AAMI PB70:2012 and meet AAMI Level 3 barrier level protection for a surgical gown.

Table 3 - General Comparison
ItemProposed device(K222999)Predicated device(K211509)Remark
Product CodeFYAFYASame
Regulation No.21 CFR 878.404021 CFR 878.4040Same
ClassIIIISame
Product nameSurgical GownSurgical GownSame
510(k) No.K222999K211509/
ModelsS,M,L,XL,XXLS,M,L,XL,XXLSame
IntendedUse/Indications forUseSurgical Gowns are intended to be worn by operating room personnelduring surgical procedures to protect the surgical patient andoperating room personnel from the transfer of microorganisms, bodyfluids and particulate material. This surgical gown meets therequirements of AAMI Level 3 barrier protection for a surgicalgown per ANSI/AAMI PB70:2012 Liquid barrier performance andclassification of protective apparel and drapes intended for use inhealth care facilities (AAMI PB70). The Surgical Gowns are singleSame
Surgical Gowns are intended to be worn by operating room personnelduring surgical procedures to protect the surgical patient and operatingroom personnel from the transfer of microorganisms, body fluids andparticulate material. This surgical gown meets the requirements ofAAMI Level 3 barrier protection for a surgical gown per ANSI/AAMIPB70:2012 Liquid barrier performance and classification ofprotective apparel and drapes intended for use in health carefacilities (AAMI PB70). The Surgical Gowns are single use, disposable
use, disposable medical devices;provided non-sterile. Before theuse, the Surgical Gowns must besterilized by EO sterilization basedon ISO 11135:2014.medical devices; provided non-sterile.
MaterialSMS nonwoven fabricpolyester fiberSleeve/body(polyethylene SMS Nonwoven)Similar
ColorBlueBlueSame
SterilitySterile for end-userSterile for end userSame
Single UseYesYesSame
Impact Penetration≤1.0 g≤1.0 gSame
HydrostaticResistance>50 cm>50 cmSame
Tensile strengthMachine direction mean≥32.9 lbf;Cross direction mean≥26.3 lbf.Machine direction mean≥27.8 lbf;Cross direction mean≥19.1 lbf* Gap 1
Tear resistanceMachine direction mean≥9.3 lbf;Cross direction mean≥18.2 lbfMachine direction mean≥10.7 lbf;Cross direction mean≥6.2 lbf* Gap 2
Steam strengthShoulder: 48.7NArmhole:33.9NSleeve: 49.6NShoulder: 71.8NArmhole: 66.0NSleeve: 77.0N* Gap 3
16 CFR Part 1610FlammabilityMeets requirements of FlameResistant CPSC 1610 Class 1Meets requirements of FlameResistant CPSC 1610 Class 1Same
LintingLog10<4Log10<4Same
Liquid barrierperformanceLevel 3 AAMI PB70Level 3 AAMI PB70Same
CytotoxicityUnder the condition of the test, nopotential cytotoxicityUnder the condition of the test, nopotential cytotoxicitySame
IrritationSensitizationUnder the condition of the test, noirritation and sensitizationUnder the condition of the test, noirritation and sensitizationSame
Acute systemictoxicityUnder the condition of acutesystemic toxicity test, the testarticle did not show acute systemictoxicity in vivo.//
SterilizationModalityEthylene Oxide (EO)Ethylene Oxide (EO)Same

tah

7.0Technological Characteristic Comparison Table

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  • Gap analysis:

Gap 1-3, the two devices have some little deviation in product performance, but the difference in the performance test result does not raise additional questions for safety and effectiveness.

8.0 Non-Clinical Test Conclusion

The proposed device was tested and conformed to the related recognized standards and the requirements stated in the "Guidance on Premarket Notification [510(k)] Submissions for Surgical Gowns and Surgical Drapes" dated August, 1993.

Based on ASTM F2407-20 Standard Specification for Surgical Gowns Intended for Use in Healthcare Facilities, the subject device has been conducted the test as following:

AATCC 42-2013 Water Resistance: Impact Penetration Test

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AATCC 127-2014 Water Resistance: Hydrostatic Pressure Test

ASTM D5034-09(2017) Standard Test Method for Breaking Strength and Elongation of Texile Fabrics (Grab Test)

ASTM D5587-15(2019) Standard Test Method for Tearing Strength of Fabrics by Trapezoid Procedure

ASTM D1683-17(2018) Standard Test Method for Failure in Sewn Seams of Woven Apparel Fabrics

ASTM F1868-17(2017) Standard Test Method for Thermal and Evaporative Resistance of Clothing Materials Using a Sweating Hot Plate

ISO 9073-10:2003 Textiles - Test methods for nonwovens - Part 10: Lint and other particles generation in the dry state

16 CFR Part 1610(a) Standard for The Flammability of Clothing Textiles

ISO 11737-2:2019 Sterilization of health care products - Microbiological methods - Part 2: Tests of sterility performed in the definition, validation and maintenance of a sterilization process

TestMethodologyPurposeAcceptance CriteriaResults
AATCC 42Impact PenetrationLevel 3, ≤1.0g<1.0g
AATCC 127HydrostaticResistanceLevel 3, ≥50cm≥50cm
ASTM D5034Tensile strengthMachine direction mean:≥18 lbf;Cross direction mean: ≥12lbf.Machine direction mean≥32.9 lbf;Cross direction mean≥26.3 lbf.
ASTM D5587Tear resistanceFarbic direction A mean:≥4.0 lbf;Farbic direction B mean:≥2.5 lbf;Machine direction mean≥9.3 lbf;Cross direction mean≥18.2 lbf.
ASTM D1683Seam strengthShoulder: ≥8.5 lbf;Arm opening: ≥5.5 lbf;Sleeve: ≥8.5 lbf;Shoulder: ≥10.1 lbf;Arm opening: ≥7.2 lbf;Sleeve: ≥10.1 lbf;
ASTM F1868EvaporativeResistance offabricsMean EvaporativeResistance(Ref)≥0.06(kPa·m²/W).Mean EvaporativeResistance(Ref)≥0.06(kPa·m²/W).
ISO 9073-10Lint and Otherparticlesgeneration in thedry stateLog 10 < 4Index for Particulate Matter(IPM)< 2.89
16 CFR Pat1610FlammabilitytestingClass 1, Non FlammableClass 1, Non Flammable
CytotoxicityBiocompatibility-cytotoxicityUnder the condition of thetest, no potentialcytotoxicityUnder the condition of the test,no potential cytotoxicity
IrritationBiocompatibility-irritationUnder the condition of thetest, no irritationUnder the condition of the test,no irritation
SensitizationBiocompatibility-sensitizationUnder the condition of thetest, no sensitizationUnder the condition of the test,no sensitization
Acute systemictoxicityBiocompatibility-Acute systemictoxicityUnder the condition of acutesystemic toxicity test, thetest article did not showacute systemicUnder the condition of acutesystemic toxicity test, the testarticle did not show acutesystemic

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toxicity in vivo.toxicity in vivo.
Ethylene oxideresiduesThe test wasperformed inaccordance with ISO10993-7:2008Ethylene oxidesterilization residualsto determine the EOand ECH residualsof the test sample.EO ≤ 4mg/deviceECH ≤ 9mg/deviceEO: 3.68 mg/deviceECH: 0.94 mg/device

9.0 Clinical Test Conclusion

No clinical study implemented for the Surgical Gown.

10.0 Conclusion

The conclusion drawn from the nonclinical tests demonstrates that the subject device, the Surgical Gown is as safe, as effective, and performs as well as or better than the legally marketed predicate device K211509.

§ 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.