KIMBERLY-CLARK KC100 SURGICAL DRAPES, MODEL KC 100, KIMBERLY-CLARK KC100 SURGICAL EQUIPMENT COVERS, MODEL KC 100

K083234 · Kimberly-Clark Corp. · KKX · Mar 25, 2009 · General, Plastic Surgery

Device Facts

• Record ID: K083234
• Device Name: KIMBERLY-CLARK KC100 SURGICAL DRAPES, MODEL KC 100, KIMBERLY-CLARK KC100 SURGICAL EQUIPMENT COVERS, MODEL KC 100
• Applicant: Kimberly-Clark Corp.
• Product Code: KKX · General, Plastic Surgery
• Decision Date: Mar 25, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4370
• Device Class: Class 2

Intended Use

Kimberly-Clark Corporation intends to market the sterile KC100 Surgical Drapes as devices made of natural or synthetic material intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. Kimberly-Clark intends to market the sterile KC100 Surgical Equipment Covers which are protective barrier covers that are intended to be used to cover surgical equipment and provide a protective barrier for that equipment.

Device Story

Sterile surgical drapes and equipment covers; used in clinical settings to isolate surgical sites and protect equipment from contamination. Drapes consist of natural or synthetic materials (SMS, polyethylene, air-laid pads); equipment covers consist of polyethylene with air-laid reinforcement. Devices act as physical barriers to prevent microbial transfer. Used by surgical staff during procedures. Benefits include reduced risk of surgical site contamination and equipment protection.

Clinical Evidence

Bench testing only. Testing included biocompatibility (cytotoxicity, irritation, sensitization per ISO 10993), barrier properties, tensile strength, tear strength, alcohol repellency, and flammability. All results met acceptance criteria.

Technological Characteristics

Materials: SMS (spunbond-meltblown-spunbond), polyethylene, air-laid absorbent pads. Physical barrier principle. Sterile. No software or electronic components.

Indications for Use

Indicated for use as protective patient coverings to isolate surgical incision sites from microbial/other contamination and as protective barrier covers for surgical equipment.

Regulatory Classification

Identification

A surgical drape and drape accessories is a device made of natural or synthetic materials intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. The device includes a plastic wound protector that may adhere to the skin around a surgical incision or be placed in a wound to cover its exposed edges, and a latex drape with a self-retaining finger cot that is intended to allow repeated insertion of the surgeon's finger into the rectum during performance of a transurethral prostatectomy.

Special Controls

*Classification.* Class II (special controls). The device, when it is an ear, nose, and throat surgical drape, a latex sheet drape with self-retaining finger cot, a disposable urological drape, a Kelly pad, an ophthalmic patient drape, an ophthalmic microscope drape, an internal drape retention ring (wound protector), or a surgical drape that does not include an antimicrobial agent, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

Predicate Devices

• proMedical Surgical Drapes and proMedical Surgical Equipment Covers (K080629)

Submission Summary (Full Text)

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# K083234

# 510(k) Summary for the Kimberly-Clark* Corporation KC100 Surgical Drapes and Equipment Covers

MAR 2 5 2009

| Date Summary<br>was Prepared: | October 31, 2008 |
|---------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Submitter: | Thomas Kozma<br>Director, Regulatory Affairs<br>Kimberly-Clark Health Care<br>1400 Holcomb Bridge Road<br>Roswell, GA 30076<br>Ph: 770.587.8393<br>FAX: [phone]<br>Email: [e-mail] |
| Primary Contact<br>for this 510(k)<br>Submission: | Lisa Peacock, Consultant to Kimberly-Clark Health Care<br>SciMed, Inc.<br>Ph: 706.216.3413<br>FAX: [phone]<br>Email: [e-mail] |
| Device Common<br>Name: | Sterile surgical drapes and surgical equipment covers |
| Device Product<br>Codes and<br>Classification<br>Names: | KKX Surgical Drapes<br>MMP Protective Barrier Covers |
| Intended Use: | Kimberly-Clark Corporation intends to market the sterile<br>KC100 Surgical Drapes as devices made of natural or<br>synthetic material intended to be used as a protective<br>patient covering, such as to isolate a site of surgical incision<br>from microbial and other contamination. Kimberly-Clark<br>intends to market the sterile KC100 Surgical Equipment<br>Covers which are protective barrier covers that are<br>intended to be used to cover surgical equipment and<br>provide a protective barrier for that equipment. |
| Predicate<br>Devices: | K080629 proMedical Surgical Drapes and proMedical<br>Surgical Equipment Covers |
| Substantial<br>Equivalence: | The surgical drapes and equipment covers described in this<br>510(k) submission are identical in all specifications to the<br>predicate device models identified in K080629 except for<br>minor variations in the widths and lengths of three models. |

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# Summary of Testing:

The KC100 Surgical Drapes and Equipment Covers are identical to, and meet the same acceptance testing criteria as, their predicate drapes and covers in K080629. Testing included biocompatibility (i.e., cytotoxicity, irritation, and sensitization) in compliance with the methods of ISO 10993, barrier properties, tensile and tear strength, alcohol repellency, and flammability. All results of testing met acceptance criteria.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

#### Public Health Service

NAR 2 5 20080

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kimberly-Clark Corporation C/o Ms. Lisa Peacock, RAC Consultant to Kimberly-Clark Health Care SciMed, Incorporated 172 Conductor Drive Dawsonville, Georgia 30534

Re: K083234

> Trade/Device Name: KC100 Surgical Drapes & KC100 Surgical Equipment Covers Regulation Number: 21 CFR 878.4370 Regulation Name: Surgical Drape and Drape Accessories Regulatory Class: II Product Code: KKX Dated: February 23, 2009 Received: February 25, 2009

Dear Ms. Peacock:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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.

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Page 2 - Ms. Peacock

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Center for Devices and Radiological Health's (CDRH's) Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Anthony D. naton bu

Ginette Y. Michaud, M.D. Acting Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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#### Indications for Use

510(k) Number (if known): K083234

Device Name: KC100 Surgical Equipment Covers

Indications for Use:

Kimberly-Clark* Corporation intends to market the sterile KC100 Surgical Equipment Covers which are protective barrier covers that are intended to be used to cover surgical equipment and provide a protective barrier for that equipment.

| Product Name | Model<br>Code | Cover Materials |
|------------------|-------------------------|-----------------------------------------------|
| Mayo Stand Cover | 88656 | Blue polyethylene with air-laid reinforcement |
| Table Cover | 88673<br>88666<br>89564 | Blue polyethylene with air-laid reinforcement |

Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use _ X (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

### Concurrence of CDRH, Office of Device Evaluation (ODE)

Shale H. Murphy, ID

(Division Sign-Oft) Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K083234

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#### Indications for Use

510(k) Number (if known): K083234

Device Name: KC100 Surgical Drapes

Indications for Use:

Kimberly-Clark* Corporation intends to market the sterile KC100 Surgical Drapes as devices made of natural or synthetic material intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. See Page 2 for product list.

Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use × (21 CFR 801 Subpart C)

# (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

#### Concurrence of CDRH, Office of Device Evaluation (ODE)

Shule A. Murphy 18
(Division Sign-Off)

Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K083234

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# Indications for Use Product List

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| Product Name | Model Code | Drape Materials |
|----------------------------------------|------------|---------------------------------------------------|
| Angiography Surgical Drape | 89583 | SMS base panel with air-laid pad and polyethylene |
| Clear Legging Surgical Drape | 89195 | Polyethylene |
| Universal Extremity Surgical<br>Drape | 89191 | SMS base panel with air-laid pad |
| Legging Surgical Drape | 70093855 | SMS panel |
| Head Surgical Drape | 70093879 | SMS panel |
| Side Surgical Drape | 89556 | SMS base panel with air-laid pad |
| Top Surgical Drape | 89554 | SMS base panel with air-laid pad |
| Bottom Surgical Drape | 89555 | SMS base panel with air-laid pad |
| Bar Surgical Drape | 89533 | SMS base panel with air-laid pad |
| Arthroscopy Surgical Drape | 88661 | SMS base panel with polyethylene |
| Under Buttocks Surgical Drape | 89584 | SMS base panel with air-laid pad and polyethylene |
| Split EENT Surgical Drape | 89197 | SMS base panel with air-laid pad |
| Lithotomy Surgical Drape | 89198 | SMS base panel with air-laid pad |
| Laparoscopy T Surgical Drape | 89199 | SMS base panel with air-laid pad |
| Thyroid Surgical Drape | 89539 | SMS base panel with air-laid pad |
| Minor Procedure Surgical<br>Drape | 89531 | SMS base panel with air-laid pad |
| Lap Chole Surgical Drape | 89538 | SMS base panel with air-laid pad |
| Cystoscopy T Surgical Drape | 89196 | SMS base panel with air-laid pad |
| Chest Surgical Drape | 89561 | SMS base panel with air-laid pad |
| Utility Surgical Drape | 89536 | Air-laid absorbent panel |
| Split Surgical Drape | 89190 | Polyethylene |
| U Surgical Drape | 89532 | SMS base panel with air-laid pad |
| Laparotomy Surgical Drape | 89537 | SMS base panel with air-laid pad |
| Shoulder Arthroscopy Surgical<br>Drape | 89558 | SMS base panel with polyethylene |
| Body Split Surgical Drape | 89560 | SMS base panel with air-laid pad and polyethylene |
| Body Split Surgical Drape | 89557 | SMS base panel with air-laid pad |
| Half Surgical Drape | 89534 | SMS panel |
| Large Surgical Drape | 79535 | SMS panel |
| Universal Spine Surgical Drape | 89193 | SMS base panel with air-laid pad and polyethylene |
| Dental Surgical Drape | 89543 | SMS base panel with air-laid pad |
| Stockinette Surgical Drape | 044001-700 | Polyethylene stockinette |

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