← Product Code [FRG](/submissions/HO/subpart-g%E2%80%94general-hospital-and-personal-use-miscellaneous-devices/FRG) · K240330

# HALYARD* SMART-FOLD* Sterilization Wrap (H450); HALYARD* SMART-FOLD* Sterilization Wrap (H650) (K240330)

_O&M Halyard, Inc. · FRG · Aug 7, 2024 · General Hospital · SESE_

**Canonical URL:** https://fda.innolitics.com/submissions/HO/subpart-g%E2%80%94general-hospital-and-personal-use-miscellaneous-devices/FRG/K240330

## Device Facts

- **Applicant:** O&M Halyard, Inc.
- **Product Code:** [FRG](/submissions/HO/subpart-g%E2%80%94general-hospital-and-personal-use-miscellaneous-devices/FRG.md)
- **Decision Date:** Aug 7, 2024
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 880.6850
- **Device Class:** Class 2
- **Review Panel:** General Hospital

## Indications for Use

HALYARD SMART-FOLD Sterilization Wrap (H450 and H650) is intended to enclose another medical device that is to be sterilized by a healthcare provider using the Advanced Sterilization Products STERRAD 100NX Sterilizer ULTRA GI Cycle. The H450 and H650 models of the HALY ARD SMART-FOLD Sterilization Wrap have been validated for use with the STERRAD 100NX ULTRA GI Cycle as follows: • Hydrogen peroxide compatible flexible multi-channel duodenoscopes, with no more than 4 channels, with lumen dimensions of ≥1mm inner diameter x ≤1500mm in length, or ≥2mm inner diameter x ≤1630mm in length. · One flexible duodenoscope per tray, and no more than two flexible duodenoscope per cycle Note 1: The STERRAD 100NX Sterilizer ULTRA GI Cycle was validated using a load weight of 15.4 lbs (2 x 7.7 lbs), one endoscope per shelf. Note 2: Only duodenoscopes that have been cleared as compatible with vaporized hydrogen peroxide are acceptable. Check STERRAD Sterilizer Cycle Selection table for ULTRA GI Cycle compatible duodenoscopes The HALYARD SMART-FOLD Sterilization Wrap (H450, H650) is intended to allow sterilization of the enclosed medical device(s) and to maintain sterility of the enclosed device(s) until used.

## Device Story

Sterilization wrap system; consists of two pre-shaped polypropylene SMS sheets with reinforcement zones, placement reference lines, and closure tabs. Used by healthcare providers to wrap medical devices (specifically flexible duodenoscopes) prior to sterilization in STERRAD 100NX ULTRA GI cycle. Wrap allows sterilant penetration while maintaining sterile barrier post-processing. Protects enclosed devices from contamination until point of use. Single-use, non-sterile supply.

## Clinical Evidence

No clinical data; bench testing only. Testing included sterilant penetration/efficacy (ISO 14937, AAMI TIR 12), physical property testing (ANSI/AAMI/ISO 11607-1, ISO 13938-2, ASTM D4966-12, CPSC 1610), package integrity maintenance (up to 90 days), and biocompatibility (ISO 10993 series). All tests met acceptance criteria.

## Technological Characteristics

Three-layer SMS (spunbond-meltblown-spunbond) polypropylene fabric with antistatic treatment. Pre-shaped sheets with reinforcement zones and closure strips. Sterilization via hydrogen peroxide vapor. Single-use, non-sterile. Complies with ANSI/AAMI/ISO 11607-1.

## Regulatory Identification

A sterilization wrap (pack, sterilization wrapper, bag, or accessories, is a device intended to be used to enclose another medical device that is to be sterilized by a health care provider. It is intended to allow sterilization of the enclosed medical device and also to maintain sterility of the enclosed device until used.

## Predicate Devices

- SMART-FOLD Sterilization Wrap ([K181959](/device/K181959.md))

## Reference Devices

- SMART-FOLD Sterilization Wrap ([K140963](/device/K140963.md))

## Submission Summary (Full Text)

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August 7, 2024

O&M Halyard, Inc. Anureet Singh Regulatory Affairs Manager 9120 Lockwood Blvd Mechanicsville, Virginia 23116

# Re: K240330

Trade/Device Name: HALYARD* SMART-FOLD* Sterilization Wrap (H450); HALYARD* SMART-FOLD* Sterilization Wrap (H650) Regulation Number: 21 CFR 880.6850 Regulation Name: Sterilization Wrap Regulatory Class: Class II Product Code: FRG Dated: February 2, 2024 Received: February 5, 2024

# Dear Anureet Singh:

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.

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).

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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).

Sincerely,

Image /page/1/Picture/6 description: The image shows a digital signature. The signature includes the name "Stephen A. Anisko -S" on two lines on the left side of the image. On the right side of the image, the text "Digitally signed by Stephen A. Anisko -S" is present, along with the date "2024.08.07" and the time "16:07:04 -04'00'".

for: Christopher Dugard Assistant Director DHT4C: 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

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Enclosure

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# Indications for Use

510(k) Number (if known) K240330

#### Device Name

HALYARD* SMART-FOLD* Sterilization Wrap (H450); HALYARD* SMART-FOLD* Sterilization Wrap (H650)

#### Indications for Use (Describe)

HALYARD SMART-FOLD Sterilization Wrap (H450 and H650) is intended to enclose another medical device that is to be sterilized by a healthcare provider using the Advanced Sterilization Products STERRAD 100NX Sterilizer ULTRA GI Cycle.

The H450 and H650 models of the HALY ARD SMART-FOLD Sterilization Wrap have been validated for use with the STERRAD 100NX ULTRA GI Cycle as follows:

• Hydrogen peroxide compatible flexible multi-channel duodenoscopes, with no more than 4 channels, with lumen dimensions of ≥1mm inner diameter x ≤1500mm in length, or ≥2mm inner diameter x ≤1630mm in length.

· One flexible duodenoscope per tray, and no more than two flexible duodenoscope per cycle

Note 1: The STERRAD 100NX Sterilizer ULTRA GI Cycle was validated using a load weight of 15.4 lbs (2 x 7.7 lbs), one endoscope per shelf.

Note 2: Only duodenoscopes that have been cleared as compatible with vaporized hydrogen peroxide are acceptable. Check STERRAD Sterilizer Cycle Selection table for ULTRA GI Cycle compatible duodenoscopes

The HALYARD SMART-FOLD Sterilization Wrap (H450, H650) is intended to allow sterilization of the enclosed medical device(s) and to maintain sterility of the enclosed device(s) until used.

| Type of Use (Select one or both, as applicable)                                                                            |                                                                                                                                      |
|----------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------|
| <div style="display:flex; align-items:center;"><input type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D)</div> | <div style="display:flex; align-items:center;"><input checked="" type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C)</div> |

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# 510(k) Summary K240330

| Submitter:                             | O&M Halyard, Inc.<br>9120 Lockwood Boulevard<br>Mechanicsville, VA 23116<br>Phone: 804-723-7000/800-488-8850<br>Fax: 804-723-7100                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|----------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Regulatory Contact:                    | Anureet Singh<br>Regulatory Affairs Manager                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| Date of Summary:                       | 05 August 2024                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |
| Device Trade Name:                     | HALYARD* SMART-FOLD* Sterilization Wrap (H450);<br>HALYARD* SMART-FOLD* Sterilization Wrap (H650)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| Common Name:                           | Sterilization Wrap                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
| Classification Name:                   | Sterilization wrap (21 CFR 880.6850, Product Code FRG)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
| Predicate Device:<br>Reference Device: | K181959 (SMART-FOLD Sterilization Wrap)<br>K140963 (SMART-FOLD Sterilization Wrap)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
| Device Description:                    | Halyard Sterilization Wrap is supplied to the customer as bulk packages of single<br>sheets, where in accordance with standard hospital practices, two sheets are then<br>used to wrap a medical device or a collection of medical devices for sterilization.<br>HALYARD SMART-FOLD Sterilization Wraps are comprised of two sheets of<br>HALYARD* Sequential Sterilization Wrap. This allows for convenient wrapping<br>with two sheets simultaneously.<br>The HALYARD SMART-FOLD Sterilization Wraps are intended to enclose<br>another medical device that is to be sterilized by a healthcare provider using the<br>Advanced Sterilization Products, Inc. (ASP) STERRAD 100NX Sterilizer<br>ULTRA™ GI Cycle.                          |
| Indications for Use:                   | HALYARD SMART-FOLD Sterilization Wrap (H450 and H650) is intended to<br>enclose another medical device that is to be sterilized by a healthcare provider<br>using the Advanced Sterilization Products STERRAD 100NX Sterilizer ULTRA<br>GI Cycle.<br>The H450 and H650 models of the HALYARD SMART-FOLD Sterilization<br>Wrap have been validated for use with the STERRAD 100NX ULTRA GI Cycle<br>as follows:<br>• Hydrogen peroxide compatible flexible multi-channel duodenoscopes, with no<br>more than 4 channels, with lumen dimensions of ≥1mm inner diameter x<br>≤1500mm in length, or ≥2mm inner diameter x ≤1630mm in length.<br>• One flexible duodenoscope per tray, and no more than two flexible<br>duodenoscope per cycle |

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Note 1: The STERRAD 100NX Sterilizer ULTRA GI Cycle was validated using a load weight of 15.4 lbs (2 x 7.7 lbs), one endoscope per shelf.

Note 2: Only duodenoscopes that have been cleared as compatible with vaporized hydrogen peroxide are acceptable. Check STERRAD Sterilizer Cycle Selection table for ULTRA GI Cycle compatible duodenoscopes

The HALYARD SMART-FOLD Sterilization Wrap (H450, H650) is intended to allow sterilization of the enclosed medical device(s) and to maintain sterility of the enclosed device(s) until used.

Technological Characteristics Comparison Table:

|                            | Proposed<br>HALYARD SMART-<br>FOLD Sterilization Wrap                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate<br>HALYARD SMART-<br>FOLD Sterilization Wrap<br>(K181959)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | Reference<br>KIMGUARD Smart-Fold<br>Sterilization Wrap<br>(K140963)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Comparison                                                                            |
|----------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|
| Manufacturer               | O&M Halyard, Inc.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Halyard Health, Inc.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | Kimberly-Clark Health Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Different                                                                             |
| Device<br>Model<br>Numbers | H450<br>H650                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | H450<br>H650                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | KC450<br>KC650                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Same                                                                                  |
| Common or<br>Usual Name    | Sterilization Wrap                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Sterilization Wrap                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | Sterilization Wrap                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Same                                                                                  |
| Classification             | 21 CFR 880.6850                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | 21 CFR 880.6850                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | 21 CFR 880.6850                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Same                                                                                  |
| Class                      | II                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | II                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | II                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Same                                                                                  |
| Product Code               | FRG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | FRG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | FRG                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Same                                                                                  |
| Intended Use               | Intended to allow sterilization<br>of the enclosed medical<br>device(s) and also maintain<br>sterility of the enclosed<br>device(s) until used.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | Intended to allow sterilization<br>of the enclosed medical<br>device(s) and also maintain<br>sterility of the enclosed<br>device(s) until used.                                                                                                                                                                                                                                                                                                                                                                                                                              | Intended to allow sterilization<br>of the enclosed medical<br>device(s) and also maintain<br>sterility of the enclosed<br>device(s) until used.                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Same                                                                                  |
| Indications<br>for Use     | HALYARD SMART-FOLD<br>Sterilization Wrap (H450 and<br>H650) is intended to enclose<br>another medical device that is<br>to be sterilized by a healthcare<br>provider using the Advanced<br>Sterilization Products<br>STERRAD 100NX Sterilizer<br>ULTRA GI Cycle.<br><br>The H450 and H650 models of<br>the HALYARD SMART-<br>FOLD Sterilization Wrap have<br>been validated for use with the<br>STERRAD 100NX ULTRA<br>GI Cycle as follows:<br>• Hydrogen peroxide<br>compatible flexible multi-<br>channel duodenoscopes, with<br>no more than 4 channels, with<br>lumen dimensions of ≥1mm<br>inner diameter x ≤1500mm in                                                                                                                                                         | HALYARD SMART-FOLD*<br>Sterilization Wrap (H450,<br>H650) is intended to enclose<br>another medical device that is<br>to be sterilized by a healthcare<br>provider using Steris V-PRO<br>Low Temperature Sterilization<br>system that includes:<br><br>• V-PRO 1 (Lumen Cycle)<br>• V- PRO 1 Plus (Lumen and<br>Non-Lumen Cycle)<br>• V-PRO maX, V-PRO maX 2<br>and V-PRO 60 (Lumen, Non-<br>Lumen, and Flexible Cycle)<br><br>The HALYARD SMART-<br>FOLD* Sterilization Wrap<br>(H450, H650) is intended to<br>allow sterilization of the<br>enclosed medical device(s) and | KIMGUARD* Smart Fold*<br>Sterilization Wrap (KC450 and<br>KC650) is intended to be used<br>to enclose another medical<br>device that is to be sterilized<br>by a healthcare provider using:<br>Advanced Sterilization<br>Products' STERRAD<br>Sterilization Systems that<br>include:<br>o STERRAD 100S<br>o STERRAD NX [Standard<br>Cycle, Advanced Cycle]<br>o STERRAD 100NX).<br>[Standard Cycle, Flex Cycle,<br>EXPRESS cycle, DUO Cycle]<br><br>KIMGUARD* Smart Fold*<br>Sterilization Wraps (KC450<br>and KC650) are intended to<br>allow sterilization of the<br>enclosed medical device(s) and | Different,<br>includes<br>additional<br>indications for<br>Use for ULTRA<br>GI cycle. |
|                            | length, or ≥2mm inner<br>diameter x ≤1630mm in<br>length.<br>• One flexible duodenoscope<br>per tray, and no more than two<br>flexible duodenoscope per<br>cycle<br>Note 1: The STERRAD<br>100NX Sterilizer ULTRA GI<br>Cycle was validated using a<br>load weight of 15.4 lbs (2 x 7.7<br>lbs), one endoscope per shelf.<br>Note 2: Only duodenoscopes<br>that have been cleared as<br>compatible with vaporized<br>hydrogen peroxide are<br>acceptable. Check STERRAD<br>Sterilizer Cycle Selection table<br>for ULTRA GI Cycle<br>compatible duodenoscopes<br><br>The HALYARD SMART-<br>FOLD Sterilization Wrap<br>(H450, H650) is intended to<br>allow sterilization of the<br>enclosed medical device(s) and<br>to maintain sterility of the<br>enclosed device(s) until used. | to maintain sterility of the<br>enclosed device(s) until used.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | also maintain sterility of the<br>enclosed device(s) until used.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |                                                                                       |
| Device<br>Design           | Two pre-shaped sheets of<br>Halyard Sterilization Wrap,<br>which include reinforcement<br>zones, medical device<br>placement reference line, a<br>white inner layer, side-tabs<br>with closure strips and pull-<br>tabs to allow convenient<br>wrapping with two sheets<br>simultaneously                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | Two pre-shaped sheets of<br>Halyard Sterilization Wrap,<br>which include reinforcement<br>zones, medical device<br>placement reference line, a<br>white inner layer, side-tabs<br>with closure strips and pull-<br>tabs to allow convenient<br>wrapping with two sheets<br>simultaneously                                                                                                                                                                                                                                                                                    | Two pre-shaped sheets of<br>Halyard Sterilization Wrap,<br>which include reinforcement<br>zones, medical device<br>placement reference line, a<br>white inner layer, side-tabs<br>with closure strips and pull-<br>tabs to allow convenient<br>wrapping with two sheets<br>simultaneously                                                                                                                                                                                                                                                                                                             | Same                                                                                  |
| Sterilant                  | Hydrogen Peroxide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Hydrogen Peroxide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Hydrogen Peroxide                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | Same                                                                                  |
| Technology                 | Polypropylene SMS material<br>that allows sterilant to<br>penetrate and maintain sterile<br>barrier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | Polypropylene SMS material<br>that allows sterilant to<br>penetrate and maintain sterile<br>barrier                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | Polypropylene SMS material<br>that allows sterilant to<br>penetrate and maintain sterile<br>barrier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Same                                                                                  |
| Materials                  | Each sheet is composed of a<br>three-layer SMS<br>(spunbond-meltblown-<br>spunbond) polypropylene<br>fabric treated with an antistatic<br>treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                | Each sheet is composed of a<br>three-layer SMS<br>(spunbond-meltblown-<br>spunbond) polypropylene<br>fabric treated with an antistatic<br>treatment.                                                                                                                                                                                                                                                                                                                                                                                                                         | Each sheet is composed of a<br>three-layer SMS<br>(spunbond-meltblown-<br>spunbond) polypropylene<br>fabric treated with an antistatic<br>treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Same                                                                                  |
| Distribution               | Non-Sterile<br>Over-the-Counter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | Non-Sterile<br>Over-the-Counter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | Non-Sterile<br>Over-the-Counter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Same                                                                                  |
| Single Use<br>Device       | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Same                                                                                  |

O&M Halyard, Inc.

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Summary of Non-Clinical Performance Testing:

Performance testing of HALYARD SMART-FOLD Sterilization Wrap was evaluated and the results showed that acceptance criteria were met demonstrating that the HALYARD SMART-FOLD Sterilization Wrap allows sterilization of its contents using the STERRAD 100NX Sterilizer ULTRA GI Cycle and that sterility is maintained for the testing period of 90 days.

| Purpose                                                                  | Test                                                                                  | Acceptance Criteria                                                                              | Result |
|--------------------------------------------------------------------------|---------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------|--------|
| Sterilant<br>Penetration/Efficacy                                        | ISO 14937<br>AAMI TIR No 12-2010                                                      | Achieving a 10-6 sterility assurance level<br>following processing in a worst-case<br>half-cycle | Pass   |
| Performance Testing<br>(Pre-Sterilization<br>and Post-<br>Sterilization) | ANSI/AAMI/ISO 11607-1 Annex B<br>ISO 13938-2<br>ASTM D4966-12<br>CPSC 1610            | Complies with the selected physical<br>properties                                                | Pass   |
| Maintenance of<br>Package Integrity                                      | ANSI/AAMI/ISO 11607-1<br>ANSI/AAMI ST79<br>AAMI TIR No 12-2010<br>ANSI/AAMI/ISO 14937 | Maintain sterility for up to 90 days                                                             | Pass   |
| Biocompatibility                                                         | ISO 10993-1<br>ISO 10993-5<br>ISO 10993-10<br>ISO 10993-12<br>ISO 14937               | Non-cytotoxic<br>Non-irritating<br>Residual level ≤ 9100 µg/cm2                                  | Pass   |

### Summary of Non-Clinical Testing Performed

Summary of Clinical Performance Testing:

Clinical evaluations were not required and therefore are not submitted with this 510(k).

### Discussion:

The HALY ARD SMART-FOLD Sterilization Wrap in this submission and the predicate device submission are intended to enclose another medical device that is to be sterilized by a healthcare provider, to allow sterilization of the enclosed medical device(s) and to maintain sterility of the enclosed device(s). The SMART-FOLD Sterilization Wrap in this submission and the predicate device submission have identical intended use, design, materials, specifications, and composition, and are manufactured using identical production methods. The different technological characteristics, that is, the Indications for Use, do not affect the safety and effectiveness of the device as evidenced by the results of the nonclinical testing.

## Conclusion:

The conclusions drawn from the non-clinical tests demonstrate that the HALYARD SMART-FOLD Sterilization Wrap (K240330) is as safe, as effective, and performs as well as or better than the legally marketed device, the HALYARD SMART-FOLD Sterilization Wrap (K181959).

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**Source:** [https://fda.innolitics.com/submissions/HO/subpart-g%E2%80%94general-hospital-and-personal-use-miscellaneous-devices/FRG/K240330](https://fda.innolitics.com/submissions/HO/subpart-g%E2%80%94general-hospital-and-personal-use-miscellaneous-devices/FRG/K240330)

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