3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228

K192673 · 3M Company · JOJ · Oct 28, 2019 · General Hospital

Device Facts

• Record ID: K192673
• Device Name: 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228
• Applicant: 3M Company
• Product Code: JOJ · General Hospital
• Decision Date: Oct 28, 2019
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 880.2800
• Device Class: Class 2

Intended Use

Use the 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 to secure packs and as an external pack process indicator to differentiate unprocessed items from items processed in the STERRAD® 100, STERRAD® 100S, STERRAD® NX (Standard and Advanced cycles), STERRAD® 100NX (Standard, Flex, Express and Duo cycles), STERRAD® NX with ALLClear™ Technology (Standard and Advanced cycles), STERRAD® 100NX with ALLClear™ Technology (Standard, Flex, Express and Duo cycles), AMSCO® V-PRO® 1 (Lumen cycle), AMSCO® V-PRO® 1 Plus (Lumen and Non Lumen cycles), AMSCO® V-PRO® maX, Low Temperature Sterilization System (Lumen, and Flexible cycles), AMSCO® V-PRO® 60 Low Temperature Sterilization System (Lumen, Non Lumen and Flexible cycles), and AMSCO® V-PRO™ maX 2 Low Temperature Sterilization System (Lumen and Flexible, and Fast Non Lumen cycles) sterilizers. The tape is suitable for use on non-woven disposable wraps and peel pouches. The chemical indicator stripes turn from blue toward pink after exposure to vaporized hydrogen peroxide.

Device Story

Device is a chemical indicator tape used to secure sterilization packs and provide visual confirmation of exposure to vaporized hydrogen peroxide. Consists of non-cellulosic plastic backing with pressure-sensitive adhesive and chemical indicator stripes. Upon exposure to vaporized hydrogen peroxide, stripes transition from blue to pink. Used in healthcare facilities to differentiate processed from unprocessed items. Provides immediate visual feedback to clinicians/technicians, ensuring items have undergone the sterilization cycle. Benefits patient safety by preventing the use of non-sterilized equipment.

Clinical Evidence

Bench testing only. Performance verified in AMSCO® V-PRO™ maX 2 Low Temperature Sterilization System. Testing confirmed color change from blue to pink, determined minimum exposure parameters, and validated endpoint color stability for 12 months under fluorescent light.

Technological Characteristics

Non-cellulosic plastic backing; pressure-sensitive adhesive; chemical indicator stripes (blue to pink transition). Standalone physical indicator. No energy source or software. 18-month shelf life.

Indications for Use

Indicated for use as an external pack process indicator to differentiate unprocessed items from items processed in specified vaporized hydrogen peroxide sterilizers. Suitable for use on non-woven disposable wraps and peel pouches.

Regulatory Classification

Identification

Biological sterilization process indicator: A device intended for use by a health care provider to accompany products being sterilized through a sterilization procedure and to monitor adequacy of sterilization. The device consists of a known number of microorganisms, of known resistance to the mode of sterilization, in or on a carrier and enclosed in a protective package. Subsequent growth or failure of the microorganisms to grow under suitable conditions indicates the adequacy of sterilization. Physical/chemical sterilization process indicator: A device intended for use by a health care provider to accompany products being sterilized through a sterilization procedure and to monitor one or more parameters of the sterilization process. The adequacy of the sterilization conditions as measured by these parameters is indicated by a visible change in the device.

Predicate Devices

• 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 (K183209)

Submission Summary (Full Text)

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October 28, 2019

3M Company Mary Fretland Senior Regulatory Affairs Associate 3M Center, Building 275-5W-06 St. Paul, Minnesota 55144

Re: K192673

Trade/Device Name: 3MTM ComplyTM Hydrogen Peroxide Indicator Tape 1228 Regulation Number: 21 CFR 880.2800 Regulation Name: Sterilization Process Indicator Regulatory Class: Class II Product Code: JOJ Dated: September 25, 2019 Received: September 30, 2019

Dear Mary Fretland:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal

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statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

For Elizabeth Claverie, M.S. Assistant Director for THT4B2 Acting Assistant Director for THT4B1 DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known) K192673

#### Device Name

3M™ ComplyTM Hydrogen Peroxide Indicator Tape 1228

#### Indications for Use (Describe)

Use the 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 to secure packs and as an external pack process indicator to differentiate unprocessed items from items processed in the STERRAD® 100, STERRAD® 100S, STERRAD® NX (Standard and Advanced cycles), STERRAD® 100NX (Standard, Flex, Express and Duo cycles), STERRAD® NX with ALLClear™ Technology (Standard and Advanced cycles), STERRAD® 100NX with ALLClear™ Technology (Standard, Flex, Express and Duo cycles), AMSCO® V-PRO® 1 (Lumen cycle), AMSCO® V-PRO® 1 Plus (Lumen and Non Lumen cycles), AMSCO® V-PRO® maX, Low Temperature Sterilization System (Lumen, and Flexible cycles), AMSCO® V-PRO® 60 Low Temperature Sterilization System (Lumen, Non Lumen and Flexible cycles), and AMSCO® V-PRO™ maX 2 Low Temperature Sterilization System (Lumen and Flexible, and Fast Non Lumen cycles) sterilizers. The tape is suitable for use on non-woven disposable wraps and peel pouches. The chemical indicator stripes turn from blue toward pink after exposure to vaporized hydrogen peroxide.

| 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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Image /page/3/Picture/1 description: The image shows the 3M logo. The logo is red and features the number 3 followed by the letter M. The 3 and M are connected and bolded.

# 510(k) Summary for 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228

# K192673

#### Sponsor Information:

3M Health Care 3M Center, Bldg. 275-5W-06 St. Paul, MN 55144-1000

Contact: Mary Fretland Senior Regulatory Affairs Associate Phone Number: [phone] Fax Number: [phone]

Date of Summary: October 26, 2019

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#### PREMARKET NOTIFICATION [510(k)] 3MTM ComplyTM Hydrogen Peroxide Indicator Tape 1228

#### 1. Device Name and Classification:

| Common or Usual Name: | Chemical Indicator |
|------------------------|--------------------------------------------------------------|
| Proprietary Name: | 3M TM Comply TM Hydrogen Peroxide Chemical Indicator<br>1228 |
| Classification Name: | Indicator, physical/chemical sterilization process |
| Device Classification: | Class II, 21 CFR § 880.2800 |
| Product Code: | JOJ |

#### 2. Predicate Device:

K183209 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228

#### 3. Description of Device:

The 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 consists of a noncellulosic plastic backing material with a pressure-sensitive adhesive on one side and chemical indicator stripes on the other side. The chemical indicator stripes turn from blue toward pink after exposure to vaporized hydrogen peroxide.

#### 4. Indications for Use

Use the 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 to secure packs and as an external pack process indicator to differentiate unprocessed items from items processed in the STERRAD® 100, STERRAD® 100S, STERRAD® NX (Standard and Advanced cycles), STERRAD® 100NX (Standard, Flex, Express and Duo cycles), STERRAD® NX with ALLClear™ Technology (Standard and Advanced cycles), STERRAD® 100NX with ALLClear™ Technology (Standard, Flex, Express and Duo cycles), AMSCO® V-PRO® 1 (Lumen cycle), AMSCO® V-PRO® 1 Plus (Lumen and Non-Lumen cycles), AMSCO® V-PRO® maX, Low Temperature Sterilization System (Lumen, Non-Lumen, and Flexible cycles), AMSCO® V-PRO® 60 Low Temperature Sterilization System (Lumen, Non-Lumen and Flexible cycles), and AMSCO® V-PRO™ maX 2 Low Temperature Sterilization System (Lumen, Non-Lumen, Flexible, and Fast Non-Lumen cycles) sterilizers. The tape is suitable for use on non-woven disposable wraps and peel pouches. The chemical indicator stripes turn from blue toward pink after exposure to vaporized hydrogen peroxide.

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| | Submission Device (K192673): | Predicate Device (K183209): |
|--------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Feature | 3M™ Comply™ Hydrogen Peroxide<br>Indicator Tape 1228 | 3M™ Comply™ Hydrogen Peroxide<br>Indicator Tape 1228 |
| Indications for use | Use the 3M™ Comply™ Hydrogen<br>Peroxide Indicator Tape 1228 to secure<br>packs and as an external pack process<br>indicator to differentiate unprocessed items<br>from items processed in the STERRAD®<br>100, STERRAD® 100S, STERRAD® NX<br>(Standard and Advanced cycles),<br>STERRAD® 100NX (Standard, Flex,<br>Express and Duo cycles), STERRAD® NX<br>with ALLClear™ Technology (Standard<br>and Advanced cycles), STERRAD®<br>100NX with ALLClear™ Technology<br>(Standard, Flex, Express and Duo cycles),<br>AMSCO® V-PRO® 1 (Lumen cycle),<br>AMSCO® V-PRO® 1 Plus (Lumen and<br>Non-Lumen cycles), AMSCO® V-PRO®<br>maX, Low Temperature Sterilization<br>System (Lumen, Non-Lumen, and Flexible<br>cycles), AMSCO® V-PRO® 60 Low<br>Temperature Sterilization System (Lumen,<br>Non-Lumen and Flexible cycles), and<br>AMSCO® V-PRO™ maX 2 Low<br>Temperature Sterilization System (Lumen,<br>Non-Lumen, Flexible, and Fast Non-Lumen<br>cycles) sterilizers. The tape is suitable for<br>use on non-woven disposable wraps and<br>peel pouches. The chemical indicator stripes<br>turn from blue toward pink after exposure to<br>vaporized hydrogen peroxide. | Use the 3M™ Comply™ Hydrogen<br>Peroxide Indicator Tape 1228 to secure<br>packs and as an external pack process<br>indicator to differentiate unprocessed items<br>from items processed in the STERRAD®<br>100, STERRAD® 100S, STERRAD® NX<br>(Standard and Advanced cycles),<br>STERRAD® 100NX (Standard, Flex,<br>Express and Duo cycles), STERRAD® NX<br>with ALLClear™ Technology (Standard and<br>Advanced cycles), STERRAD® 100NX<br>with ALLClear™ Technology (Standard,<br>Flex, Express and Duo cycles), AMSCO®<br>V-PRO® 1 (Lumen cycle), AMSCO® V-<br>PRO® 1 Plus (Lumen and Non-Lumen<br>cycles), AMSCO® V-PRO® maX Low<br>Temperature Sterilization System (Lumen,<br>Non-Lumen, and Flexible cycles), and<br>AMSCO® V-PRO® 60 Low Temperature<br>Sterilization System (Lumen, Non-Lumen<br>and Flexible cycles) sterilizers. The tape is<br>suitable for use on non-woven disposable<br>wraps and peel pouches. The chemical<br>indicator stripes turn from blue toward pink<br>after exposure to vaporized hydrogen<br>peroxide. |
| Sterilizers and<br>Sterilization<br>Cycles | STERRAD® 100<br>STERRAD® 100S<br>STERRAD® NX (Standard and Advanced<br>cycles)<br>STERRAD® NX with ALLClear™<br>Technology (Standard and Advanced<br>cycles)<br>STERRAD® 100NX (Standard, Flex,<br>Express, and Duo cycles)<br>STERRAD® 100NX with ALLClear™<br>Technology (Standard, Flex, Express, and<br>Duo cycles)<br>AMSCO® V-PRO™ 1 (Lumen cycle)<br>AMSCO® V-PRO™ 1 Plus (Lumen and<br>Non-Lumen cycles)<br>AMSCO® V-PRO™ maX Low<br>Temperature Sterilization System (Lumen,<br>Non-Lumen and Flexible cycles) | STERRAD® 100<br>STERRAD® 100S<br>STERRAD® NX (Standard and Advanced<br>cycles)<br>STERRAD® NX with ALLClear™<br>Technology (Standard and Advanced cycles)<br>STERRAD® 100NX (Standard, Flex,<br>Express, and Duo cycles)<br>STERRAD® 100NX with ALLClear™<br>Technology (Standard, Flex, Express, and<br>Duo cycles)<br>AMSCO® V-PRO™ 1 (Lumen cycle)<br>AMSCO® V-PRO™ 1 Plus (Lumen and<br>Non-Lumen cycles)<br>AMSCO® V-PRO™ maX Low Temperature<br>Sterilization System (Lumen, Non-Lumen<br>and Flexible cycles) |
| Feature | Submission Device (K192673):<br>3M™ Comply™ Hydrogen Peroxide<br>Indicator Tape 1228 | Predicate Device (K183209):<br>3M™ Comply™ Hydrogen Peroxide<br>Indicator Tape 1228 |
| | AMSCO® V-PRO™ 60 (Lumen, Non-<br>Lumen and Flexible cycles)<br>AMSCO® V-PRO™ maX 2 Low<br>Temperature Sterilization System (Lumen,<br>Non-Lumen, Flexible, and Fast Non-Lumen<br>cycles) | |
| Substrate | Non-cellulosic plastic | Identical |
| Biocompatibility | The exposure to health care professionals is<br>minimal and well below any identified toxic<br>thresholds for the compounds. | Identical |
| Color Change | Blue toward pink | Identical |
| Detection | Hydrogen Peroxide | Identical |
| Stability of the<br>endpoint reaction | Twelve (12) months | Identical |
| Shelf life | Eighteen (18) months | Identical |

## 5. Technological Characteristic Comparison Table

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#### PREMARKET NOTIFICATION [510(k)] 3M™ ComplyTM Hydrogen Peroxide Indicator Tape 1228

The 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 is the same design as the previously cleared device of the same model number (the predicate) which is sold under the tradename 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 (K183209). No changes have been made to the device materials or fundamental technology.

#### 6. Summary of Non-clinical Testing

To demonstrate performance in the newly claimed sterilizer and cycles, nonclinical testing was performed in accordance with the FDA Guidance for Industry and Staff: Premarket Notification [510(k)] Submissions for Chemical Indicators, issued December 19, 2003. Reference Table 6.1 for testing completed in the AMSCO® V-PRO™ maX 2 Low Temperature Sterilization System (Lumen, Non-Lumen, Flexible, and Fast Non-Lumen cycles).

| Test | Purpose | Acceptance Criteria | Result |
|--------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------|--------|
| Color Change in<br>Health Care<br>Facility Cycle | To demonstrate the color change of<br>the device when used in the<br>AMSCO® V-PRO™ maX 2 Low<br>Temperature Sterilization System | Color change from blue toward<br>pink | Pass |
| Minimum<br>Exposure<br>Parameters | To determine the minimum time<br>required for the color change of the<br>device when used in the AMSCO®<br>V-PRO™ maX 2 Low Temperature<br>Sterilization System | Determination of the minimum<br>time for color to change from<br>blue toward pink | Pass |
| End Point Color<br>Stability | To demonstrate the post-<br>sterilization color stability of the<br>device after use in the AMSCO® V-<br>PRO™ maX 2 Low Temperature<br>Sterilization System | No significant color change<br>after exposure to fluorescent<br>light for a minimum of twelve<br>(12) months. | Pass |

### Table 6.1 Summary of Nonclinical Testing

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### 7. Conclusion

Based on the non-clinical performance data, the 3MTM Comply™ Hydrogen Peroxide Indicator Tape 1228 is as safe, as effective, and performs as well as or better than the legally marketed predicate, 3M™ Comply™ Hydrogen Peroxide Indicator Tape 1228 cleared under K183209, Class II (21 CFR 880.2800), product code JOJ.