Disposable Surgical Gown

K212591 · Suzhou Janee Medical Technology Co., Ltd. · FYA · Jan 11, 2022 · General, Plastic Surgery

Device Facts

• Record ID: K212591
• Device Name: Disposable Surgical Gown
• Applicant: Suzhou Janee Medical Technology Co., Ltd.
• Product Code: FYA · General, Plastic Surgery
• Decision Date: Jan 11, 2022
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4040
• Device Class: Class 2

Intended Use

The Disposable Surgical Gowns are intended to be worn by operating room personnel during surgical procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate matter. In addition, this surgical gown meets the requirements of AAMI Level 3 barrier protection for a surgical gown per ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities (AAMI PB70). This is a single use, disposable device, provided sterile.

Device Story

Disposable surgical gown; poly-reinforced front chest and sleeves using PP/PE composite breathable film; base material polyolefin (polypropylene) SMS nonwoven. Used by operating room personnel to protect patient and staff from fluid/microorganism transfer. Single-use; sterile; provided in sizes M, L, XL, TL. Provides AAMI Level 3 barrier protection.

Clinical Evidence

No clinical data. Bench testing only. Performance verified via AAMI/ANSI PB70:2012, ASTM D5587-15 (tear), ASTM D5034-21 (breaking strength), ASTM D1683M-17 (seam strength), AATCC 42-2013 (impact penetration), ASTM F1868-17 (evaporative resistance), AATCC 127-2014 (hydrostatic pressure), CPSC 16 CFR 1610-2008 (flammability), ISO 9073-10:2003 (linting), and ISO 10993-5/10 (biocompatibility).

Technological Characteristics

Material: Polyolefin (polypropylene) SMS nonwoven; critical zone reinforced with PP/PE composite breathable film. Barrier: AAMI Level 3 per ANSI/AAMI PB70:2012. Sterilization: Sterile. Form factor: Disposable gown in sizes M, L, XL, TL.

Indications for Use

Indicated for operating room personnel during surgical procedures to provide barrier protection against microorganisms, body fluids, and particulate matter. Meets AAMI Level 3 requirements.

Regulatory Classification

Identification

Surgical apparel are devices that are intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operating room personnel from transfer of microorganisms, body fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe covers, and isolation masks and gowns. Surgical suits and dresses, commonly known as scrub suits, are excluded.

Special Controls

*Classification.* (1) Class II (special controls) for surgical gowns and surgical masks. A surgical N95 respirator or N95 filtering facepiece respirator is not exempt if it is intended to prevent specific diseases or infections, or it is labeled or otherwise represented as filtering surgical smoke or plumes, filtering specific amounts of viruses or bacteria, reducing the amount of and/or killing viruses, bacteria, or fungi, or affecting allergenicity, or it contains coating technologies unrelated to filtration (e.g., to reduce and or kill microorganisms). Surgical N95 respirators and N95 filtering facepiece respirators are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9, and the following conditions for exemption:(i) The user contacting components of the device must be demonstrated to be biocompatible. (ii) Analysis and nonclinical testing must: (A) Characterize flammability and be demonstrated to be appropriate for the intended environment of use; and (B) Demonstrate the ability of the device to resist penetration by fluids, such as blood and body fluids, at a velocity consistent with the intended use of the device. (iii) NIOSH approved under its regulation. (2) Class I (general controls) for surgical apparel other than surgical gowns and surgical masks. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9.

Predicate Devices

• Cardinal Health™ Non-Reinforced Surgical Gown (K170762)

Submission Summary (Full Text)

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January 11, 2022

Suzhou JaneE Medical Technology Co., Ltd % Ivy Wang Consultant Shanghai Sungo Management Consulting Company Limited 14 th Floor, 1500# Central Avenue Shanghai, Shanghai 200122 China

Re: K212591

Trade/Device Name: Disposable Surgical Gown Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FYA Dated: December 8, 2021 Received: December 8, 2021

Dear Ivy Wang:

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 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 ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

For Clarence W. Murray III, PhD Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K212591

Device Name Disposable Surgical Gown

#### Indications for Use (Describe)

The Disposable Surgical Gowns are intended to be worn by operating room personnel during surgical procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate matter. In addition, this surgical gown meets the requirements of AAMI Level 3 barrier protection for a surgical gown per ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities (AAMI PB70). This is a single use, disposable device, provided sterile.

| 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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# 510(K) Summary K212591

#### A. Applicant:

Suzhou JaneE Medical Technology Co., Ltd. Address: No.339 HuaFeng Road, New District, Suzhou, Jiangsu Province, China, 215129 Contact person: Mr. Zhu Li Tel: [phone] Email: [e-mail]

Submission Correspondent: Primary contact: Ms. Ivy Wang Shanghai SUNGO Management Consulting Co., Ltd. 14th Floor, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: [phone] Email: [e-mail] Secondary contact: Mr. Raymond Luo 14th Floor, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: [phone]

Email: [e-mail]

## B. Device:

Trade Name: Disposable Surgical Gown Common Name: Surgical Gown Model(s): Reinforced

Regulatory Information Classification Name: Gown, Surgical Classification: Class II Product code: FYA Regulation Number: 878.4040 Review Panel: Surgical Apparel

## C. Predicate device:

K170762 Cardinal Health™ Non-Reinforced Surgical Gown Cardinal Health 200, LLC

#### D. Intended use of the device:

The Disposable Surgical Gowns are intended to be worn by operating room personnel during surgical

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Suzhou JaneE Medical Technology Co., Ltd. No.339 HuaFeng Road, New District, Suzhou, Jiangsu Province, China, 215129

procedures to protect the surgical patient and operating room personnel from the transfer of microorganisms, body fluids and particulate matter. This is a single use, disposable device, provided sterile.

## E. Device Description:

The proposed device is a poly-reinforced surgical gown, the critical zone is front chest and sleeves. The critical zone is reinforced with PP/PE composite breathable film. The proposed device is available in four different sizes, include M, L, XL,TL. The proposed devices can meet the requirements for Level 3 per ANSVAAMI PB70:2012. The proposed devices are disposable medical devices and provided sterile.

| Device | Proposed Device | Predicate Device | Result |
|--------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------|
| Manufacturer | Suzhou JaneE Medical<br>Technology Co., Ltd. | Cardinal Health™ | - |
| 510K number | K212591 | K170762 | - |
| Product Name | Disposable Surgical Gown | Cardinal Health™ Non-<br>Reinforced Surgical Gown | - |
| Classification | Class II Device, FYA (21<br>CFR878.4040) | Class II Device, FYA (21<br>CFR878.4040) | Same |
| Intended Use | The Disposable Surgical<br>Gowns are intended to be<br>worn by operating room<br>personnel during surgical<br>procedures to protect the<br>surgical patient and<br>operating room personnel<br>from the transfer of<br>microorganisms, body<br>fluids and particulate<br>matter. In addition, this<br>surgical gown meets the<br>requirements of AAMI<br>Level 3 barrier protection<br>for a surgical gown per<br>ANSI/AAMI PB70:2012<br>Liquid barrier<br>performance and<br>classification of<br>protective apparel and<br>drapes intended for use in<br>health care facilities | Cardinal Health™ Non-<br>Reinforced Surgical Gown is<br>intended to be worn by<br>operating room personnel<br>during surgical procedures to<br>protect the surgical patient and<br>operating room personnel from<br>the transfer of microorganisms,<br>body fluids and particulate<br>material. In addition, this<br>surgical gown meets the<br>requirements of AAMI Level 3<br>barrier protection for a surgical<br>gown per ANSI/AAMI<br>PB70:2012 Liquid barrier<br>performance and classification<br>of protective apparel and drapes<br>intended for use in health care<br>facilities (AAMI PB70). The<br>Cardinal Health™ Non-<br>Reinforced Surgical Gowns are<br>single use, disposable medical | Same |
| | | | |
| | (AAMI PB70). This is a<br>single use, disposable<br>device, provided sterile. | devices; provided sterile and<br>non-sterile. | |
| Material<br>Composition | Polyolefin<br>(Polypropylene) SMS<br>nonwoven | Polyolefin (Polypropylene)<br>SMS nonwoven | Same |
| Sterility | Sterile | Sterile and non-sterile | Same |
| Use | Single Use; Disposable | Single Use; Disposable | Same |
| Color | Blue | Blue | Same |
| Size | M,L,XL,TL | M-S, M, L, XL, XXL | Similar. No<br>effect on<br>safety or<br>efficacy |
| Weight per<br>square(g) | Critical Area: 87.8g/m²<br>Non-Critical Area:<br>45.12g/m² | 31g/m² (1.32 oz/yd²) | Similar. No<br>effect on<br>safety or<br>efficacy.<br>Both passed<br>performance<br>tests. |
| Tensile | MD: 16.18 lbs (72N) CD:<br>13.26 lbs (59N) | MD Mean 21.57 lbs CD Mean<br>13.6 lbs | Similar. No<br>effect on<br>safety or<br>efficacy.<br>Both passed<br>performance<br>tests. |
| Tear | MD:22.25 lbs (99 N)<br>CD:18.20 lbs (81N) | MD Mean 3.47 lbs CD Mean<br>5.63 lbs | Similar. No<br>effect on<br>safety or<br>efficacy.<br>Both passed<br>performance<br>tests. |
| Seam Strength | Sleeve Seam:68.3N<br>Side Seam:69.7N<br>Belt Seam:71N | No available | Similar. No<br>effect on<br>safety or<br>efficacy.<br>Both passed<br>performance<br>tests. |
| Hydrostatic<br>Pressure(cm)<br>AATCC-127 | >50 cm | >50 cm | Same |
| Water Impact (g)<br>AATCC-42 | ≤1.0 g | ≤1.0 g | Same |
| Resistance to<br>blood and liquid<br>penetration | Level 3 AAMI PB70 | Level 3 AAMI PB70 | Same |
| Biocompatibility | Under the conditions of the study, the device extract was not cytotoxic.<br><br>Under the conditions of the study, the non-polar and polar device extracts were not found to be an irritant.<br><br>Under conditions of the study, the non-polar and polar device extracts were not found to be a sensitizer. | | Same |

#### F. Comparison with predicate device

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Suzhou JaneE Medical Technology Co., Ltd. No.339 HuaFeng Road, New District, Suzhou, Jiangsu Province, China, 215129

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## G. Non-Clinical Test Conclusion

Non-clinical tests were conducted to verify that the proposed device met all design specifications. The subject surgical gown was assessed for performance using the following Standards and Test Methods. The test results demonstrated that the proposed device met its acceptance criteria or testing endpoints.

| Test Methodology | Test Methodology<br>Purpose | Acceptance Criteria | Results |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------|--------------------------------------------------------------------------------------------------------------------|
| AAMI/ANSI<br>PB70:2012, Liquid<br>Barrier Performance<br>and Classification of<br>protective Apparel and<br>Drapes Intended For<br>Use In Health Care<br>Facilities. | The tests were<br>performed to determine<br>the classification of<br>subject surgical gown<br>product. | N/A | Level 3 |
| ASTM D5587-15,<br>Standard Test Method<br>for Tearing Strength of<br>Fabrics by Trapezoid<br>Procedure | The test was performed<br>in accordance with<br>ASTM D5587:<br>2015(2019) Standard<br>Test Method for<br>Tearing Strength of<br>Fabrics by Trapezoid<br>Procedure to evaluate<br>the tearing strength of<br>the test sample. | >30N | PASS<br>72/59N<br>(Average result from 3<br>nonconsecutive batches) |
| ASTM D5034-21,<br>Standard Test Method<br>for Breaking Strength<br>and Elongation of<br>Textile Fabrics (Grab<br>Test) | The test was performed<br>In accordance with<br>ASTM D5034-21.<br>Standard. Test Method<br>for Breaking Strength<br>and Elongation of<br>Textile Fabrics (Grab<br>Test) to evaluate the<br>breaking strength of the<br>test sample. | >10N | PASS<br>99/81N<br>(Average result from 3<br>nonconsecutive batches) |
| ASTM D1683M-17<br>Standard Test Method<br>for Failure in Sewn<br>Seams of Woven<br>Fabrics. | The test was performed<br>In accordance with<br>ASTM D1683M-17<br>Standard. Test Method<br>for Seam Strength of<br>Textile Fabrics (Grab<br>Test) to evaluate<br>Failure in Sewn Seams<br>of the test sample. | >30N | PASS<br>Sleeve Seam:68.3N<br>Side Seam:69.7N<br>Belt Seam:71N<br>(Average result from 3<br>nonconsecutive batches) |
| | | | |
| AATCC 42-2013,<br>Water Penetration<br>Resistance: Impact<br>Penetration Test; | The test was performed<br>in accordance with<br>AATCC 42: 2013<br>Water Resistance:<br>Impact Penetration Test<br>to evaluate the water<br>impact of the test<br>sample. | ≤1.0 g | PASS<br>0~0.019 g<br>(Average result from 3<br>nonconsecutive batches) |
| Evaporative Resistance<br>ASTM F1868-17 | The test was performed<br>in accordance with<br>ASTM F1868-17 to<br>evaluate the<br>Evaporative Resistance<br>of the test samples | < 3 Pa.m²/W. | PASS<br>2.46 Pa.m²/W.<br>(Average result from 3<br>nonconsecutive batches) |
| AATCC 127-2014,<br>Water Resistance:<br>Hydrostatic Pressure<br>Test: | The test was performed<br>in accordance with<br>AATCC 127: 2014<br>Water Resistance:<br>Hydrostatic Pressure<br>Test to determine the<br>hydrostatic pressure of<br>the test sample. | >50 cm | PASS<br>52~290 cm<br>(Average result from 3<br>nonconsecutive batches) |
| CPSC 16 CFR Part<br>1610-2008, Standard<br>for the Flammability of<br>clothing textiles | The test was performed<br>in accordance with 16<br>CFR Part 1610<br>Standard for the<br>Flammability of<br>Clothing Textiles to<br>evaluate the<br>flammability of the test<br>sample. | Meets Class I<br>requirements | PASS<br>Class I<br>(Average result from 3<br>nonconsecutive batches) |
| ISO 9073- 10:2003(E)<br>Lint and Other Particles<br>Generation | The test was performed<br>in accordance with ISO<br>9073-10: 2003 Textiles-<br>Test Methods for<br>Nonwovens-Part 10:<br>Lint and Other Particles<br>Generation in the Dry<br>State to evaluate the<br>linting of the test<br>sample. | Log10(particle count) < 4 | PASS<br>3.0<br>(Average result from 3<br>nonconsecutive batches) |
| | | | |
| ISO 10993-10: 2010<br>Biological Evaluation<br>of Medical Devices -<br>Part 10: Tests For<br>Irritation And Skin<br>Sensitization | The purpose of the<br>biocompatibility testing<br>is to demonstrate the<br>biocompatibility of the<br>subject device. | Non-irritating, and<br>Non-sensitizing. | PASS<br>Under the conditions of<br>the study, the device is<br>non-irritating, and non-<br>sensitizing. |
| ISO 10993-5: 2009<br>Biological Evaluation<br>of Medical Devices --<br>Part 5: Tests For In<br>Vitro Cytotoxicity | The purpose of the<br>biocompatibility testing<br>is to demonstrate the<br>biocompatibility of the<br>subject device. | Non-cytotoxic. | PASS<br>Under the conditions of<br>the study, the device is<br>non-cytotoxic. |

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## H. Clinical Test Conclusion

No clinical study is included in this submission.

#### Conclusion I.

Based on the comparison and analysis above, the subject device, K212591 Disposable Surgical Gown, is as safe, as effective, and performs as well as the legally marketed predicate device, Disposable Surgical Gowns cleared under K170762.