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510(k) Data Aggregation

    K Number
    K221173
    Date Cleared
    2022-07-06

    (72 days)

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

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

    Device Description

    The subject device is a non-sterile, single-use, and flat pleated mask with ear loops and a Nose piece. The product is manufactured with three layers, the inner and outer layer is made of polypropylene spunbond, the middle layer is made of melt blown polypropylene. The elastic ear loops are not made with natural rubber latex. The Nose piece in the layers of the face mask is to allow the user to fit the face mask around their nose, which is made of polyethylene coated iron wire. The mask will be provided in black and blue color, the colorant for the model 0868F is Carbon black (CAS No.1333-86-4), and for the model 0866F is Pigment Blue 15 (CAS No.147-14-8). The model 0866F will be provided in blue and labeled in Level 3, the model 0868F will be provided in black and labeled in Level 1.

    AI/ML Overview

    The provided document is a 510(k) Premarket Notification for a Surgical Mask. It details the device's technical specifications, intended use, and a comparison to predicate devices, along with performance and biocompatibility testing. The document does not describe an AI/ML-driven medical device, but rather a traditional medical device (a surgical mask).

    Therefore, the requested information regarding acceptance criteria, study details (sample size, data provenance, expert ground truth, adjudication, MRMC study, standalone performance, training set details) for an AI/ML device is not applicable to this document.

    The document focuses on demonstrating substantial equivalence to predicate devices through physical and performance testing, rather than through a clinical study involving AI/ML performance metrics.

    Here's a breakdown of the information that is available related to the device's performance, as per the tables in the document, interpreted as "acceptance criteria" and "reported performance" for a surgical mask:

    1. Table of Acceptance Criteria and Reported Device Performance (Non-AI/ML)

    The document presents performance data for two models of the surgical mask (0868F and 0866F), which align with different performance levels (Level 1 and Level 3, respectively, based on ASTM F2100 standards).

    Test ItemAcceptance Criteria (Level 1 for 0868F)Reported Performance (0868F)Acceptance Criteria (Level 3 for 0866F)Reported Performance (0866F)
    Performance Testing
    Fluid Resistance (ASTM F1862)Pass at 80 mmHgPass at 80 mmHgPass at 160 mmHgPass at 160 mmHg
    Particulate Filtration Efficiency (PFE, ASTM F2299)≥ 95% (at 0.1 µm)Pass (≥ 95%)≥ 98% (at 0.1 µm)Pass (≥ 98%)
    Bacterial Filtration Efficiency (BFE, ASTM F2101)≥ 95%Pass (≥ 95%)≥ 98%Pass (≥ 98%)
    Differential Pressure (ΔP, EN 14683 / ASTM F2100)< 5.0 mm H2O/cm²Pass (< 5.0 mm H2O/cm²)< 6.0 mm H2O/cm²Pass (< 6.0 mm H2O/cm²)
    Flammability (16 CFR Part 1610)Class 1Class 1Class 1Class 1
    Biocompatibility Testing
    Cytotoxicity (ISO 10993-5)Non-cytotoxicPassNon-cytotoxicPass
    Irritation (ISO 10993-10)Non-irritatingPassNon-irritatingPass
    Sensitization (ISO 10993-10)Non-sensitizingPassNon-sensitizingPass

    Points 2-9 (Specific to AI/ML Device Study Design) are Not Applicable:

    Since this document describes a surgical mask and not an AI/ML device, the following points are not addressed:

    • 2. Sample sized used for the test set and the data provenance: Not applicable. Performance is evaluated on physical samples of the mask, not a data test set.
    • 3. Number of experts used to establish the ground truth... and their qualifications: Not applicable. Ground truth for a surgical mask is based on standardized physical and chemical tests, not expert interpretation of AI outputs.
    • 4. Adjudication method (e.g. 2+1, 3+1, none) for the test set: Not applicable.
    • 5. If a multi reader multi case (MRMC) comparative effectiveness study was done...: Not applicable. This is for evaluating changes in human diagnostic performance with AI assistance.
    • 6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable.
    • 7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.): The "ground truth" for a surgical mask's performance is established by the standardized test methods themselves (e.g., ASTM F1862 for fluid resistance, ASTM F2101 for BFE).
    • 8. The sample size for the training set: Not applicable. There is no AI model to train.
    • 9. How the ground truth for the training set was established: Not applicable.

    In summary, the provided document details the regulatory clearance for a traditional medical device (surgical mask) based on established performance standards and biocompatibility, rather than a clinical study of an AI/ML device.

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