K Number
K233526
Device Name
Medline Open-back Level 3 Protective Gown
Date Cleared
2024-03-05

(125 days)

Product Code
Regulation Number
878.4040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Gown is a single use, disposable, non-solation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situations.
Device Description
The Medline Open-Back Level 3 Protective Gown is a single use, disposable, non-sterile, nonisolation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situation. The Medline Open-Back Level 3 Protective Gown meets the level 3 barrier protection requirements in accordance with ANSI/AAMI Standard PB70:2012 "Liquid Barrier Performance and Classification of Protective Apparel and Drapes intended for use in Health Care Facilities". The Medline Open-Back Level 3 Protective Gown is a blue polyethylene gown available in 3 configurations: regular/large, universal and XL. The gown has an open back with a tie for securement and thumb loops on the cuffs.
More Information

Not Found

No
The device is a disposable protective gown and the summary does not mention any AI or ML capabilities.

No
The device is described as a protective gown intended for barrier protection for healthcare personnel, not for treating or diagnosing a medical condition.

No
The device is described as a protective gown intended to provide barrier protection for healthcare personnel, not to diagnose medical conditions.

No

The device description clearly states it is a physical gown made of polyethylene, intended for barrier protection. It undergoes bench testing for physical properties like water resistance, tearing strength, and flammability, which are characteristic of a hardware device, not software.

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

Here's why:

  • Intended Use: The intended use clearly states the gown is for "healthcare personnel to provide moderate barrier protection... in non-sterile and non-patient isolation situations." This describes a physical barrier for protection, not a device used to examine specimens derived from the human body to provide information for the diagnosis, prevention, monitoring, treatment, or alleviation of disease.
  • Device Description: The description details a physical garment made of polyethylene with specific features for wearing. It does not mention any components or functions related to analyzing biological samples.
  • Performance Studies: The performance studies focus on physical properties like barrier protection, strength, and flammability, which are relevant to protective apparel, not diagnostic tests.
  • Lack of IVD Characteristics: There is no mention of analyzing samples, reagents, calibrators, controls, or any other elements typically associated with in vitro diagnostics.

Therefore, the Medline Open-Back Level 3 Protective Gown is a medical device, but it falls under the category of personal protective equipment (PPE) and not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Gown is a single use, disposable, non-sterile, non-isolation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situations.

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

QPC

Device Description

The Medline Open-Back Level 3 Protective Gown is a single use, disposable, non-sterile, nonisolation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situation. The Medline Open-Back Level 3 Protective Gown meets the level 3 barrier protection requirements in accordance with ANSI/AAMI Standard PB70:2012 "Liquid Barrier Performance and Classification of Protective Apparel and Drapes intended for use in Health Care Facilities".

The Medline Open-Back Level 3 Protective Gown is a blue polyethylene gown available in 3 configurations: regular/large, universal and XL. The gown has an open back with a tie for securement and thumb loops on the cuffs.

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 personnel / non-sterile and non-patient isolation situations.

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)

Biocompatibility Testing
Study Type: Biocompatibility Evaluation
Tests Performed: Cytotoxicity (ISO 10993-5:2009), Sensitization (ISO 10993-10:2021), Irritation (ISO 10993-10:2021)
Key Results: All tests passed.

Performance Testing (Bench)
Study Type: Non-clinical verification of safety, performance, and functionality.
Tests Performed:

  • AATCC 127: 2018 Water Resistance: Hydrostatic Pressure Test
  • AATCC 42: 2017 Water Resistance: Impact Penetration
  • ASTM D5587-15 (2019) Standard Test Method for Tearing Strength of Fabrics by Trapezoid Procedure
  • ASTM D1683/D1683M-17:2017/(R)2018 Standard Test Method for Failure in Sewn Seams of Woven Fabrics
  • ASTM D3776/D3776M-20 Test Methods for Mass Per Unit Area (Weight) of Woven Fabric
  • ASTM D5034-21 Standard Test Method for Breaking Strength and Elongation of Textile Fabrics (Grab Test)
  • ASTM D882:2018 Tensile Properties of Thin Plastic Sheeting
  • ASTM D1004-2021 Tear Resistance (Graves Tear) of Plastic Film and Sheeting
  • 16 CFR Part 1610 Standard for the Flammability of Clothing Textiles
    Key Results: All performance tests passed, meeting the specified criteria including AAMI PB70 Level 3 requirements for barrier protection for Hydrostatic Pressure Test and Impact Penetration. The flammability test met Class 1 "normal Flammability" in accordance to 16 CFR Part 1610.

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

Cytotoxicity: Test scores

§ 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.

0

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 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.

March 5. 2024

Medline Industries, LP Kelsey Closen Official Correspondent 1 Three Lakes Drive Northfield, Illinois 60093

Re: K233526/S001

Trade/Device Name: Medline Open-Back Level 3 Protective Gown Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: QPC Dated: January 18, 2024 Received: February 1, 2024

Dear Kelsey Closen:

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 (the 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 available 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.

1

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 mediation-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).

2

Sincerely,

Bifeng Qian -S

Bifeng Qian, MD, Ph.D. Assistant Director DHT4B: Division of Infection Control and Plastic and Reconstructive Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

3

Indications for Use

510(k) Number (if known) K233526

Device Name Medline Open-Back Level 3 Protective Gown

Indications for Use (Describe)

Gown is a single use, disposable, non-solation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situations.

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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4

510(k) SUMMARY (K233526)

Submitter / 510(k) Sponsor

Medline Industries, LP Three Lakes Drive Northfield, IL 60093

Registration Number: 1417592

Contact Person

Contact Person: Kelsey Closen, Regulatory Affairs Senior Specialist Phone: 847-949-2283 Email: KClosen@medline.com

Summary Preparation Date March 1, 2024

Type of 510(k) Submission Traditional

Device Name / Classification

Trade Name: Medline Open-Back Level 3 Protective Gown Common Name: Gown, Non-Sterile, Non-Isolation, Intended To Provide Moderate Barrier Protection Classification Name: Gown, Non-Sterile, Non-Isolation, Intended To Provide Moderate Barrier Protection Product Code: OPC Classification Panel: General Hospital Regulatory Class: II Regulation Number: 21 CFR 878.4040

Predicate Device

ProTEC-USA EZDoff Gown cleared in K210405.

Device Description

The Medline Open-Back Level 3 Protective Gown is a single use, disposable, non-sterile, nonisolation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situation. The Medline Open-Back Level 3 Protective Gown meets the level 3 barrier protection requirements in accordance with ANSI/AAMI Standard PB70:2012 "Liquid Barrier Performance and Classification of Protective Apparel and Drapes intended for use in Health Care Facilities".

The Medline Open-Back Level 3 Protective Gown is a blue polyethylene gown available in 3 configurations: regular/large, universal and XL. The gown has an open back with a tie for securement and thumb loops on the cuffs.

5

Indications for Use

Gown is a single use, disposable, non-sterile, non-isolation gown intended to be worn by healthcare personnel to provide moderate barrier protection (AAMI Level 3) in non-sterile and non-patient isolation situations.

Device CharacteristicProposed DevicePredicate DeviceComparison Analysis
Product NameMedline Open-Back Level 3
Protective GownProTEC-USA EZDoff GownN/A
510(k) ReferenceK233526K210405N/A
Product OwnerMedline Industries, LPCadillac Products, Inc.N/A
Product CodeQPCQPCSame
Regulation Number878.4040878.4040Same
Intended UseGown is a single use, disposable,
non-sterile, non-isolation gown
intended to be worn by healthcare
personnel to provide moderate
barrier protection (AAMI Level 3)
in non-sterile and non-patient
isolation situations.ProTEC-USA EZDoff Gown is intended to
protect health care patients and health care
personnel from the transfer of
microorganisms, body fluids and particulate
material. The ProTEC-USA EZDoff Gown
is a single use, disposable gown provided
non-sterile. The back of the gown is open
and non-protective. The gown is not
intended for use in the operating room.Same - Medline's intended use mimics the
product codes definition.
Design FeaturesDesign includes open back, thumb
loops, back perforation for easy
removal and waist tieDesign includes open back, thumb loops,
back perforation for easy removal and waist
tieSame
Design ConfigurationsLarge/Regular, Universal, XLUniversal SizeSimilar - The difference in sizing does not
impact the safety or effectiveness of the
device. Performance testing supports the
difference.
ColorBlueBlueSame
MaterialsPolyethylenePolyethyleneSame
Prescription vs. OTCOTCOTCSame
Sterile vs. Non-SterileNon-SterileNon-SterileSame
Disposable vs. Non-DisposableDisposableDisposableSame
Single Use vs. ReusableSingle UseSingle UseSame
PB70 AAMI LevelLevel 3Level 3Same
Flammability 16 CFR 1610Meets Class 1 "normal
flammability " in accordance to 16
CFR Part 1610Meets Class 1 "normal flammability " in
accordance to 16 CFR Part 1610Same
Liquid Barrier/ PB70Device was tested in accordance
with AAMI PB70:2012 and meets
Level 3 requirements for an
isolation gownDevice was tested in accordance with
AAMI PB70:2012 and meets Level 3
requirements for an isolation gownSame
BiocompatibilityPass Cytotoxicity ISO 10993-5,
Sensitization, and Irritation ISO
10993-10Pass Cytotoxicity ISO 10993-5,
Sensitization, and Irritation ISO 10993-10Same
Tearing Strength/Resistance
(ASTM D5587)15.98±0.68N (Machine Direction)
9.41±0.46 (Transverse Direction)8N (Machine Direction)
22N (Transverse Direction)Same
Tensile Strength (ASTM
D5034)41.74±2.74N (Machine Direction)
30.29±3.52N (Transverse
Direction)52N (Machine Direction)
41N (Transverse Direction)Same
Seam Strength (ASTM D1683)35.01±3.91 N
7.87±0.88 lb.Not ReportedDifferent- predicate did not report seams
strength testing
Lint (ISO 9073-10)Not reported, not used in ORLog100.4).Pass
Performance Testing
Tearing
Strength/Resistance
(ASTM D5587)Performance testing - test
performed in accordance with
ASTM D5587Average tear
strength in
both machine
and cross
machine
directionASTM D5587The average tear
strength in
both Machine and
Cross- Machine
Directions was
assessed per ASTM
F2407 –
  1.                                                                                                                | Pass                                                                                                                                                                                                                                                                                                 |
    

| Tensile Strength
(ASTM D5034) | Performance testing - test
performed in accordance with
ASTM D5034 | Average
tensile
strength
in
both machine
and
cross
machine
direction | ASTM D5034 | The average
tensile strength in
both Machine
and Cross-
Machine
Directions was
assessed
per ASTM F2407 -
2020. | Pass |
| Seam Strength (ASTM
D1683) | Performance testing - test
performed in accordance with
ASTM D1683 | Average seam
strength | ASTM D1683 | The average seam
strength
values were
assessed per
ASTM F2407 -
2020 | Pass |
| Hydrostatic
Pressure Test | Performance Testing in
Accordance with AATCC
127: 2018 | Chest area
and sleeve
seam were
assessed per
AMMI PB70
Level 3 | AATCC 127 | ≥50cm | Pass |
| Impact
Penetration | Performance testing in
accordance with AATCC 42:
2017 | Chest area
and sleeve
seam were
assessed per
AMMI PB70
Level 3 | AATCC 42 | ≤1.0g | Pass |
| Mass Per Unit Area
(Weight) of Woven
Fabric | Performance Testing in accordance
with ASTM D3776/D3776M-20 | Mass per unit
weight | ASTM
D3776/D377
6 M | Basis Weight per ASTM
D3776/D3776M | Lot 1: 27.67 ± 0.58/
Lot 2: 28.00 ± 3.46
Lot 3: 30.67 ± 0.58 |
| Tensile
Properties of Thin Plastic
Sheeting | Performance testing in
accordance with ASTM D882:2018 | Tensile
Properties of
plastic | ASTM D882 | Determination of tensile
properties of plastics in
the form of thin sheeting
and films (less than 1.0
mm (0.04 in.) in
thickness). | Average Machine data for 3 Lots
Load at Break (N)
12.79±1.21
Tensile Strength (Mpa)
16.64±3.40
% Elongation at Break
410.76±50.67
Average Cross data for 3 Lots
Load at Break (N)
10.19±1.03
Tensile Strength (Mpa)
11.43±3.95
%Elongation at Break 522.42±58.80 |
| Tear
Resistance (Graves
Tear) of Plastic
Film and Sheeting | ASTM D1004-21 | Tear
resistance of
plastic with
machine | ASTM
D1004 | Determination of the
tear resistance of
flexible plastic film
and sheeting at very
low
rates of loading, 51 mm (2
in.)/min | Average Machine data for 3 Lots
Maximum Load (N)
2.93±0.34
Extension at Break (mm) 19.84±3.57
Average Cross data for 3 Lots
Maximum Load (N)
3.23±0.20
Extension at Break (mm) 22.50±1.4 |
| Flammability
of Clothing
Textiles | 16 CFR Part 1610 | Flammability
of gown
material | 16 CFR Part
1610 | Average burn time ≥
3.5s
Class 1 "normal
Flammability" in
accordance to 16
CFR Part 1610 | Pass |

8

Summary of Clinical Testing

Not applicable.

Conclusion

In accordance with 21 CFR Part 807 and based on the information provided in this premarket notification, Medline Industries, Inc. concludes that the Medline Open-Back Level 3 Protective Gown are as safe, as effective and performs as well as or better than the legally marketed predicate device ProTEC-USA EZDoff Gown cleared in K210405.