CE Marking Approval of a Medical Device (Case Study)

4 Comments / CE Marking / By Robert Packard

This case study explains the process for CE Marking approval of a medical device under the EU MDD regulations.

For this case study, I selected the same hypothetical client that I chose for my case study on Canadian Medical Device Licensing and a 510k submission to the US FDA. The product is a cyanoacrylate adhesive sold by the makers of Krazy Glue®. This hypothetical client wants to expand its target market to include the healthcare industry by repackaging and marketing the product as a topical adhesive in Europe.

My client called to ask if I could help obtain CE Marking approval. In Europe, cyanoacrylate is a medical device when it is used as a topical adhesive. My first step is to determine the device classification as per Annex IX in the Medical Device Directive (93/42/EEC as modified by 2007/47/EC). Instead of relying solely upon the Directive, I use guidance documents published on the Europa website–specifically MEDDEV 2.4/1 rev 9 (the following link explains the European MEDDEV guidance documents – http://bit.ly/Whats-a-MEDDEV).

I identified three potential device classifications: 1) Class 1 as per Rule 4 (a non-invasive device which comes into contact with injured skin, if the device is intended to be used as a mechanical barrier, for compression or absorption of exudates); 2) Class 2a as per Rule 7 (a surgically invasive device intended for short-term use [i.e., < 30 days] are in Class 2a; and 3) Class 2b as per Rule 8 (an implantable device). These three applications match the three possible indications that I identified when I was reviewing classifications for Canadian Medical Device Licensing for this product.

If this device were not required to be “sterile,” then a Class 1 device could use the Annex VII route of conformity (i.e., self-declaration). However, even generic bandages are sold as sterile devices. Therefore, whether the device is a sterile Class 1 device or a Class 2a device, obtaining CE Marking approval will still require a Notified Body’s review and approval. The most common route would be the Annex V route of conformity. If my client were to launch their product as a “glue” for internal use, then the device would require an Annex II.3 Full Quality System Certificate or the combination of an Annex V Certificate and a Type Examination Certificate (i.e., Annex III).

STOP!

The previous paragraph was hard to understand, but the source of this jargon is Article 11 of the Medical Device Directive. This one section is the best practices in European legalese. If you want to make something almost unintelligible, copy Article 11. If you’re going to understand this stuff, a flow chart of the various routes to conformity is as good as it gets (still hard to understand, but fewer words). The following simplified table is what I use in my CE Marking webinar:

What you need to know…

My client only has one product family, and they are currently selling the product in Canada for external use by healthcare professionals—not as an implant. Therefore, the device is a Class 2a device requiring an Annex V certificate. My client will need to do the following:

Select a Notified Body
Submit a Technical File for review and approval
Select a European Authorized Representative, because my client does not have a physical presence in Europe

Fortunately, my client already obtained an ISO 13485:2003 certificate with CMDCAS from their current registrar as part of the Canadian Licensing process. Therefore, the changes required for the Quality System consist of adding a few work instructions to meet European-specific requirements, such as vigilance reporting, creating a technical file, and performing clinical evaluations. My client also needs to add the European Requirements as an applicable regulatory requirement in the Quality Manual.

The more significant challenge is an assembly of a Technical File for submission. Since the product is already on the market in Canada, all of the technical requirements have been met. The documentation of these requirements now needs to be converted into a format acceptable to a Notified Body. There are three recommended strategies:

Whatever the Notified Body prefers. Some of the Notified Bodies have a checklist of requirements for a Technical File. If such a list exists, the client should organize the Technical File in the same order.
The GHTF STED format (GHTF/SG1/N011:2008). The Global Harmonization Task Force (http://bit.ly/GHTFSTEDGuidance) published this guidance document to standardize the format for submission of regulatory submissions. This is the format required for Class III and IV Canadian medical device license applications. This is also the format specified in the proposed EU Medical Device Regulations that is expected to be released in 2015.
The NB-MED recommended format (NB-MED 2.5.1/rec 5). This document was created by the “Big 5” Notified Bodies. It provides a template in a two-part format for submissions. This was the format I used most often for auditing files and for creating new files. However, the proposed EU Regulations that are anticipated for release in 2015 are closer to the format of the GHTF guidance. Therefore, I no longer recommend this format.

My client chose option 3 for organizing their Technical File because they have full reports for each of the verification and validation tests that were performed, but creating summaries for each report would take longer than assembling a Technical File with copies of each of these full reports.

In all, I estimate that the overall timescale for completing this project is about 60 days–not including review by the Notified Body. Therefore, I suggested that the client obtain a quotation from their registrar for an Annex V Certificate. In addition, I suggested hiring a consultant from Medical Device Academy to help them with the preparation of a Clinical Evaluation. Before 2010, Clinical Evaluations were only required for high-risk devices. As part of the new MDD, clinical evaluations are now needed for all devices. Since the use of and risks associated with cyanoacrylates is well characterized in published literature, my client may use a literature search method for preparing a Clinical Evaluation as per MEDDEV 2.7/1 rev 3.

My client hired an Authorized Representative to handle European registration, receive customer complaints, and to act as a liaison with the Competent Authority in the event of an adverse event. An Authorized Representative Agreement was signed, and the Authorized Representative recommended a few corrections to procedures they reviewed as part of entering the contract with a new client.

The company also hired another clinical consultant from our firm to complete a literature search and write a Clinical Evaluation in four weeks. The complete Technical File was assembled and submitted to the Notified Body electronically with seven weeks of starting the project. The Notified Body’s first round of questions was received within six weeks. The client and I prepared responses to the questions in a week and submitted them to the Notified Body. Fortunately, the responses were thorough, and the Technical File was well-organized from the start. The Notified completed their final review and recommended the product for CE Marking within three more weeks. The Notified Body conducted two-panel reviews to verify the technical, regulatory, and risk aspects of the submission. Finally, the Annex V certificate was received 12 weeks after the initial submission of the Technical File.

If you are interested in additional training or assistance with CE Marking of medical devices, please email Rob Packard (mail to: rob@fdaestar.com). We have standardized procedures to meet each of the requirements in the European Regulations and a couple of webinar recordings that explain both the Medical Device Directive and how to create a technical file or design dossier.

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Apr 7 2015

Indications for Use Case Study

Leave a Comment / 510(k) / By Robert Packard / pedicle screw, spinal system

This indications for use case study illustrates 510k requirements using the example of a spinal pedicle screw.

Indications for Use Case Study

A hypothetical new client asked me if I could help them with a 510k submission for a new pedicle screw design. The company’s device utilizes a lower-profile version of a traditional pedicle screw that is pre-packaged with rods, hooks, clamps, and nuts. The pre-packaged system is gamma-irradiated, and the product is specially designed for pediatric patients. Unfortunately, the company was only able to find similar designs of pedicle screws that were for adult patients.

Identifying the FDA Regulation – Indications for Use Case Study

The applicable FDA regulation for a pedicle screw product is 21 CFR 888.3070 – pedicle screw spinal system. However, the only indication stated in this regulation is specific to “skeletally mature patients.” Therefore, the indications portion of the regulation does not apply to the subject device for my hypothetical client.

Case Study Product Classification

If you type in “pediatric” as a keyword into the product classification database, 12 different product classification codes result from that search. The applicable product classification code for this product is “OSH”—“Pedicle Screw Spinal System, Adolescent Idiopathic Scoliosis.” The definition for this product classification is: “Intended to stabilize the thoracolumbar spine as an adjunct to fusion using allograft and/or autograft to treat adolescent idiopathic scoliosis.” This is the desired indication because it is specific to pediatric patients. This product classification code also references “pedicle screw spinal system” as the regulation description, and there is a link provided for the 888.3070 regulation number.

Identifying a Predicate Device

97 establishment registration and listing entries are under the “OSH” product classification code. Medicrea Technologies, located in France, submitted one of the most recent 510k submissions (K150049) referencing this product code. Many other possible predicate devices could be used for this 510k submission. However, a recent 510k submission with the same indications for use is usually a good choice. The description of the potential predicate device in the 510k Summary indicates that the predicate is also pre-sterilized. Still, the predicate device description does not specify that it is a low-profile version. Additional research on the company’s website revealed that the PASS LP Spinal System is a low-profile polyaxial spine system. For a 510k submission, it is more important to select a predicate with the same indications rather than a predicate with all the same technological characteristics. However, This particular predicate device appears to have most of the same technological characteristics. The minor differences between the “Pass LP Spinal System” and the subject device are insignificant, and the K150049 was selected as a predicate device submission.

FDA Form 3881

The form has four sections to complete:

The 510k number is assigned by the FDA to each premarket notification submission (usually not assigned yet).
The device name is the subject of your 510k submission.
The indications for use should match the indications for the use of the predicate device, and it should be similar to the indications for use as written in the regulations for the product classification.
The type of device—prescription-only and/or over-the-counter use.

The form is completed using Adobe Acrobat Pro. The Form used to be a stand-alone document that would be included in Section 4 of the FDA eCopy, but now FDA Form 3881 is incorporated into the FDA eSTAR and PreSTAR templates. The FDA includes this page as part of the 510k Summary published on the FDA website for all 510k-cleared devices. For this case study, the 510k number is unknown. The name of the subject device is the “Miniflex Pedicle Screw Spinal System.” The indications for use are: “The Miniflex Pedicle Screw Spinal System is used for posterior non-cervical pedicle screw fixation in pediatric patients. The spinal implants are indicated as an adjunct to fusion to treat adolescent idiopathic scoliosis. The spinal implants are intended to be used with allograft and/or autograft. Pediatric pedicle screw fixation is limited to a posterior approach.” The device type is for “Prescription Use” only.

Writing Your Indications for Use

When writing an Indications for Use statement, the most straightforward approach is substituting your subject device’s name for the predicate device’s name. Ideally, you have chosen a predicate device that matches your subject device for the indications for use and the technical characteristics. However, it is possible to have a subject device with a narrower indication. For example, the predicate device may be indicated for both adult and pediatric patients, while your subject device may be specifically designed to fit pediatric patients better. For our case study, only the last paragraph of the predicate’s IFU applied to the subject device because the device was limited to pediatric use. Therefore, the last paragraph was copied, and the subject device name was substituted for the predicate device name.

Indications for Use Case Study – Broader Indications

The first step of the 510k review process is verification that the subject device has the same indications for use as the primary predicate device. Therefore, if broader indications for use are claimed for the subject device, then the 510k submission will likely be rejected as not substantially equivalent (NSE). In this case, you have a few options. One alternative for submissions that require a broader indication for use is to perform a clinical study to provide safety and efficacy for the broader indication. A second alternative is to submit a De Novo application.

You should request a pre-submission meeting with the FDA before pursuing either option. In the case of a clinical study, you should plan to provide the FDA with a clinical study synopsis that includes a benefit/risk analysis. The clinical study synopsis should also include a rationale for why the broader indication for use presents a non-significant risk if you plan to conduct the clinical study under good clinical practices (GCPs) instead of applying for an investigational device exemption (IDE). Suppose you plan to submit a De Novo application. In that case, it is recommended that you prepare a special controls guidance document before the pre-submission meeting to obtain feedback from the FDA. For novel devices of medium risk, your company may need to conduct a clinical study and submit a De Novo application.

Your Next 510k Submission

Most companies have plans for subsequent submissions to expand the functionality of the subject device. In this case, often, the subject device is the best choice of a predicate device for subsequent 510k submissions. In this case, you should attempt to make the initial application as broad as possible concerning indications for use. This will enable you to narrow the indications for use in future submissions without the device being NSE to your predicate device.

If you are interested in watching a webinar on the topic of indications for use, please visit the webinar page.

Additional 510k Training

The 510k book, “How to Prepare Your 510k in 100 Days,” is available as an eBook only with the purchase of our on-line 510k course series. Please visit the webinar page to purchase individual webinars.

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Mar 24 2015

510k Submission, Section 14-Sterilization Validation and Shelf-life

Leave a Comment / 510(k) / By Robert Packard / 510(k), 510k submissions, sterilization, sterilization validation, validation

This article explains the process for preparing the sterilization validation and shelf-life section of a 510k submission.

Sterilization validation and shelf-life, Section 14, is typically one of the last sections of a 510k submission to be completed. However, most of the work in preparing this section of your 510k submission should be completed more than a month before actually completing the associated testing. The reason why you can write this section, before receiving the results, is that your results are 99% predictable. If you are unlucky enough to be part of the 1% that have surprising results during sterilization validation, then you will need to make changes and repeat your testing.

Design Planning Aspects Related to Sterilization Validation

During your design and development process, sterilization validation testing is part of design verification testing—not design validation. This testing is verification, rather than validation because you are testing in accordance with recognized standards (i.e., design inputs) to ensure that the sterilization process parameters are adequate to consistently meet the sterility specification (i.e., design output). In your design plan, it is critical to understand which of the following three categories your sterilization process falls under:

Traditional Sterilization (e.g., ethylene oxide)
Non-traditional Sterilization (e.g., Hydrogen Peroxide)
Novel, Non-traditional Sterilization (e.g., Chlorine Dioxide)

You must identify which category your sterilization process falls into because the review process used by the FDA for each category of the sterilization process is different. Traditional sterilization processes have recognized standards that a reviewer can easily compare your validation methods with.

Non-traditional sterilization methods are becoming more popular for products that are sensitive to degradation caused by high temperature, or exposure to radiation or ethylene oxide. However, the FDA has identified non-traditional sterilization processes as being a priority for inspection. Therefore, after your product receives 510k clearance, you can expect an FDA inspection sooner than products that use traditional sterilization methods (i.e., 6-12 months instead of 12-24 months).

The novel, Non-Traditional Sterilization

The novel, non-traditional sterilization methods require a different 510k clearance process, because the FDA requires an internal consultation from the Infection Control Devices Branch (INCB) before issuing 510k clearance. A consultation is needed for evaluation of the sterilization process because reviewers lack sufficient expertise in the field of microbiology and Sterilization to evaluate novel sterilization processes. The INCB can also provide a consult for non-traditional sterilization processes, but this is not typically needed if the process is following established ISO Standards for sterilization validation.

For the novel, non-traditional sterilization processes, and INCB consult is required, and it is recommended to consult with the FDA early regarding the use of this type of sterilization process. Part of the reason for this early consultation is that a pre-clearance priority inspection is required before issuing the 510k. The FDA published draft guidance on this topic in 2008 that can be found on the following webpage – Click Here.

The image below shows where the INCB is located within the hierarchy of the FDA’s organization.

Creating Summary Technical Documentation (STED)

The sterilization validation and shelf-life section of a 510k submission may be copied from the summary technical documentation (STED) that you prepare for CE Marking applications or a Canadian Medical Device License Application. Instead of including all of the protocols and testing reports from your validations, the regulators only require a summary of the validation activities and results. If the STED is thorough and well-organized, the reviewer should not request validation reports. However, if the STED is incomplete, then the reviewer is likely to request a copy of the validation reports.

Any STED should include the following elements:

Identification of the validation dates
Identification of the organization(s) that performed the validation
Reference to the ISO standard or other recognized standard that was used
Identification of any deviations from the referenced standard
Number of lots and samples per lot tested
Description of the testing performed—including testing parameters
Identification of the document control numbers and revisions for protocols and reports
Acceptance criteria for the validation
Summary of the results

For your STED specific to sterilization validation and shelf-life, you will also need to ensure you include a description of the packaging used to maintain the device’s sterility (primary packaging) and a description of the packaging used to protect the primary packaging (i.e., secondary packaging).

For a 510k submission, you will only need to make a few modifications to the STED that you use for European CE Marking and Canadian licensing. First, you need to ensure you are referencing standards recognized by the FDA. If you followed a different method, the differences need to be documented in Section 9 of your submission on FDA Form 3654 for each Standard.

Second, you will need to include a reference to Ethylene Oxide (EO) residual testing summarized in Section 15 for biocompatibility (not applicable to non-EO methods of Sterilization). EO residual testing must be performed in accordance with ISO 10993-7. You should also include an outline of the validation methods that were used in your comparison of substantial equivalence in Section 12 of your submission. Finally, you should reference the methods used briefly in your executive summary (i.e., Section 10) and the 510k summary (i.e., Section 5)—assuming that you did not use a 510k statement.

If you are writing your first STED for sterilization validation and shelf-life, I recommend reviewing the RTA checklist in advance.

You may want to organize your STED with headlines that address each of the questions outlined in the RTA checklist.

You should also be aware that although the FDA references the 2002 guidance document K90-1 for the format and content of the sterilization validation section, there is a 2008 draft guidance the represents the FDA’s current thinking on the topic of sterilization validation. That draft guidance document is also identified as a priority for the FDA to release as a final guidance in FY 2015 (i.e., before October 1, 2015).

Additional 510k Training

The new 510k book, “How to Prepare Your 510k in 100 Days,” ships on Monday, February 6th, 2017. There is also an on-line 510k course series consisting of 24 webinars. Please visit my webinar page to purchase individual webinars. We also have live 510k workshops

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Mar 19 2015

Validating Bioburden Limits

18 Comments / Validation / By Robert Packard / bioburden, bioburden limits, setting bioburden limits

This article explains the process for setting and validating bioburden limits, and you will learn when investigations are needed.

Last week, I was in Europe reviewing product specifications with a potential contract manufacturer for a medical device implant. Due to the raw materials that the contract manufacturer currently is using for a similar product, bioburden levels are higher than we can accept. The company uses an ISO Class 7 cleanroom for assembly and packaging, which is clean enough for these implants, but the molded components used for the assembly are not clean enough.

The average bioburden is 220 CFU/device (i.e., colony-forming units/device), and the maximum observed bioburden exceeded 500 CFU/device. We want to use a lower dose range of gamma radiation to prevent the deterioration of bioabsorbable plastics, but a lower dose range requires that the average bioburden never exceed 100 CFU/device.

There are quite a few Clauses in ISO 13485 that differ from ISO 9001. One example is Clause 6.4–Work Environment. Subsection 6.4(b) states, “If work environment conditions can have an adverse effect on product quality, the organization shall establish documented requirements for the work environment conditions and documented procedures or work instructions to monitor and control these work environment conditions.” This is the applicable clause of ISO 13485 related to setting bioburden limits. Unfortunately, this vague requirement does not explain how to establish or validate bioburden limits.

Rule of Thumb for Setting Limits

One of my microbiologist friends recommends using the following “rule of thumb”: +2 sigma for alert limits and +3 sigma for action limits. This rule of thumb assumes that you are performing data analysis of bioburden and that you have calculated a “sigma” value for the standard deviation. There are a few problems with the “rule of thumb” approach.

First, this method assumes a normal distribution and a controlled process–which bioburden seldom is. Second, the cleanliness you need for your product and the cleanliness your controlled environment is capable of are not always appropriately matched. In my example, we need the finished device to have a bioburden of <100 CFU/device before gamma sterilization. Molded parts are essentially bioburden free due to the hot temperatures of the parts ejected from the mold. Unfortunately, molded components attract dust like a magnet. Therefore, how you handle and store molded parts is important to the bioburden of the molded parts.

Which factors affect bioburden?

For this example, we have three aspects critical to the final bioburden limit of the finished medical devices.

How are the molded parts handled and stored?
Are molded parts cleaned before assembly?
What is the cleanliness of the work environment where the device is assembled?

The cleanliness of the molding environment matters, but parts can fall into a container that keeps the parts clean. It also matters how molding machine operators handle the parts. Gloves should be used, and typically the container the parts are in will be placed in an outer bag for storage. It is possible to clean molded parts with ultrasonic cleaning before assembly, but if the parts are kept clean after molding, this is unnecessary.

For your assembly operation, you need an environment with suitable cleanliness. Sometimes a controlled environment is sufficient. Other times a certified cleanroom is more appropriate. In either case, it is important to control the bioburden in the assembly area to a level that meets the needs of the most critical product assembled in that area. Cleanroom procedures, the design of the cleanroom, and your cleaning/sterilization processes should match the needs of the product. Fortunately, cleanroom procedures and bioburden limits for cleanrooms are well established in ISO 14644-1 (e.g., for an ISO Class 7 cleanroom, particles ≥ 0.5 microns must be fewer than 352,000). If you have devices of different types in the same manufacturing area, you must plan according to the most critical needs.

Validating Bioburden Limits

After establishing your bioburden limits, you need to validate these limits. Once again, cleanroom validation has established ISO Standards to follow. The more challenging validation is a validation of the bioburden of parts and the final assembly. It’s important to validate the component levels first to reduce the variability of inputs to the final assembly process. Typically the first step is to perform data analysis of other molded parts produced in the same molding area by the same operators. If this data meets your needs for cleanliness, then further measures for controlling bioburden may not be needed. However, if you need to reduce bioburden (i.e., bioburden failure), you might consider measuring parts at critical control points. The goal is to identify where the bioburden is being introduced. This analysis is typical of the type of root cause investigation performed when bioburden increases for unexplained reasons.

Once the sources of bioburden are identified and quantified, process controls should be implemented to reduce bioburden. Gloves, double-bagging of product, and keeping containers covered during the molding operation are typical risk controls that may be implemented. To validate the effectiveness of these measures, you should write a bioburden validation protocol that evaluates each of the following aspects:

lot variability of component bioburden
operator variability for assembly
variability in the cleanliness of the assembly area
number of operators in the assembly area
duration of the manufacturing lots

After you have validated the bioburden limits for the components, then the same process should be conducted for the final assembly of the product. A sampling of bioburden after transfer to the assembly area and before assembly begins should be done. This is important because often, improper storage of components and/or failure to remove and clean outer packaging will contaminate the parts and your assembly area.

If you are interested in learning more about process validation, please download the process validation webinar. We also published a blog on sterilization and shelf-life validation for 510k submissions.

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Mar 10 2015

Performance Testing for a 510k Submission-Case Study-Part 2

Leave a Comment / 510(k) / By Robert Packard / 510k submission, 510k submission to the FDA (case study-part 1), FDA 510k submission, performance testing for a 510k submission-case study-part 2

Performance testing for a 510k submission case study (Part 2) explains the performance testing required for an FDA 510k submission.

Performance testing is an essential part of new product development and is usually the last section that you can complete before your submission. In my previous 510k case study article, I showed you how to research the FDA classification database to determine if there is a special controls guidance document to follow in the preparation of your 510k submission. The example I used was for topical adhesives (i.e., MPN). Topical adhesives do not have any Recognized Consensus Standards listed. Instead, all the performance testing requirements are specified in the special controls guidance document.

How to find performance testing requirements

In this case study article, I selected a different product code that has Recognized Consensus Standards, but it does not have a special controls guidance document. After identifying the device classification and product code, if there is no Special Controls Guidance, you need to plan your performance testing based upon other sources of information. If there is no Special Controls Guidance document, I use three methods for determining what performance testing is needed:

Look for any device-specific standards
Review other 510k summaries
Order previous 510k submissions via FOIA requests

To learn more about creating a 510k test plan, please see our webinar on this topic.

For this case study, the product code selected was a bone fixation screw (i.e., HWC). The number of predicate 510k submissions to choose from for this product code is extensive. There are 29 from Arthrex alone. Some of these 510k submissions include a 510k statement, while others include a 510k summary. A statement is not directly helpful in identifying any of the performance testing that was used for the clearance of the potential predicate device. However, 21 CFR 807.93 requires that the company that submitted the 510k shall provide a redacted copy of the 510k submission within 30 days of the request. If this is requested early in your 510k project, you should have a copy of the submission in time to plan your performance testing for verification and validation of the subject device. You can also order predicate 510k submissions through the Freedom of Information Act (FOIA) request process.

In the case of a 510k summary, the summary indicates what performance testing was performed to demonstrate substantial equivalence. In the case of K103705, the section titled “Substantial Equivalence Summary” states that mechanical testing data for torque and pull-out testing was submitted for the subject device and the predicate device. Other 510k summaries may provide additional data or a more descriptive list of testing that was performed. In the case of this 510k example, there is a second product code listed: HRS, bone fixation plate. The HWC bone fixation screw product code indicates that there are 5 Recognized Consensus Standards:

ASTM F2026-14 Standard Specification for Polyetheretherketone (PEEK) Polymers for Surgical Implant Applications
ASTM F 897-02 (Reapproved 2013) Standard Test Method for Measuring Fretting Corrosion of Osteosynthesis Plates and Screws
ASTM F1839-08 (Reapproved 2012) Standard Specification for Rigid Polyurethane Foam for Use as a Standard Material for Testing Orthopaedic Devices and Instruments
ASTM F983-86 (Reapproved 2013) Standard Practice for Permanent Marking of Orthopaedic Implant Components
ASTM F565-04 (Reapproved 2013) Standard Practice for Care and Handling of Orthopaedic Implants and Instruments

Only three of the above standards are included in the list of eight Recognized Consensus Standards related to the HWS product code. One of those eight standards should probably be covered under the HWC product code, as well:

ASTM F543-13 Standard Specification and Test Methods for Metallic Medical Bone Screws

Now you have a total of six different device-specific standards that can be used for planning the performance testing of your bone screw. This is significantly more helpful than a 510k summary that says torque and pull-out testing was performed. After you have ordered and reviewed each of the standards, you then create a list of performance tests that apply to your screw and create an overall verification and validation plan.

It is essential to perform this review each time, because there may be new or revised testing methods established as the Recognized Consensus Standards are updated. If you outsource testing, then you will need to obtain a quotation from a testing lab for each of the applicable tests.

Once you have created a comprehensive testing list, and you have quotations for all the testing required, you need to schedule the testing and ship samples to the testing lab. Once testing has begun, this is the best time to start the preparation of your 510k submission. Performance testing often takes several months to complete. If you start preparing the 510k before you have ordered the testing, then you are starting too early, and you may have to change your performance testing summary multiple times.

If you start your 510k preparation after you order your testing, then you can create the entire performance testing summary. The only information that you will be missing is the final report number for each test being performed. For the most part, you do not need the specific results of the testing, because the tests are designed to show that the subject device is “equivalent” or “not worse” in performance. Quantitative comparisons between your subject device and the predicate device are not allowed by the FDA for a 510k submission. Your subject device must be “equivalent” or “not worse than” the predicate device concerning safety and efficacy.

Additional 510k Training

If you enjoyed our this performance testing case study and you would like more 510k training, please search our website for more articles. We wrote a 510k book in 2017 when we first started hiring consultants to grow Medical Device Academy from an independent consulting business to a consulting firm. The book was called, “How to Prepare Your 510k in 100 Days.” Changes to the FDA 510k process have been rapid over the past 7 years, and the content is no longer relevant, but there is an on-line 510k course series consisting of 33 new FDA eSTAR webinars. You can also purchase our webinars individually.

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Mar 2 2015

510k Case Study – Part 1

6 Comments / 510(k) / By Robert Packard / 510(k), 510k FDA submission, 510k submission, 510k submission to the FDA (case study-part 1)

510k case study explains the 510k submission process in order to obtain clearance from the US FDA for marketing a new medical device.

This article is the first part of a two-part 510k case study providing an overview of the premarket notification process (i.e., 510k submission) to obtain clearance from the US FDA for marketing a new medical device. This first part of the series focuses on the initial steps of a 510k submission project: 1) identifying product classification, 2) identifying any applicable international standards and special controls guidance documents, and 3) selecting a primary predicate device.

For this 510k case study, I chose the maker of Krazy Glue^® as a hypothetical new client. The company wants to start selling cyanoacrylate as a topical adhesive in the U.S. market. As with the Canadian and European markets, the US FDA considers cyanoacrylate a medical device when it is used as a topical adhesive. The first step toward obtaining FDA clearance for marketing the new product is to determine the device’s classification.

Device Classification

My client was considering asking the FDA to identify the classification of topical adhesives using the 513(g) submission process. Still, I provided the following reasons why the client should not use the 513(g) process:

the 513(g) process takes 60 days to get a response from the FDA, while a qualified consultant can make the same determination in less than a day
hiring a consultant typically costs less than the 513(g) fee (i.e., $3,387 for large companies and $1,694 for small businesses)
the FDA’s classification determination is non-binding, and the accuracy of the FDA’s response is highly dependent upon the quality of the information provided by the company

In this 510k case study, I was able to answer the client’s question about device classification over the phone without any charge. The client indicated that they wanted to launch a product similar to Surgiseal. I was able to use the US FDA Registration and Listing Database to identify the product classification by merely typing “Surgiseal” in the field for “Proprietary Name.” Adhezion Biomedical LLC is registered as the manufacturer of Surgiseal. The three-letter product code “MPN,” and the device is a Class II device requiring premarket notification via a 510k submission.

This product classification also gives my client additional options that are not available to all companies that are trying to achieve 510(k) clearance for the first time. Most new products can only achieve initial 510(k) clearance from the US FDA by submitting a “traditional” 510(k). This process is supposed to take 90 days—assuming there are no significant questions about the submission, and the reviewer has a manageable workload to review. The average time for determination of 510k clearance is currently between 120 and 180 calendar days.

Applicable International Standards & Special Controls Guidance

For some products, there are recognized consensus standards (i.e., ISO Standards) that define the performance requirements for a medical device or a Special Controls document published by the FDA that identifies which performance Standards the FDA requires for specific product classification. In the case of topical adhesives, the FDA has issued a Special Controls document. When there is a Special Controls guidance document available, the company may submit an Abbreviated 510k instead of a Traditional 510k submission.

An Abbreviated 510k submission contains summaries of all the testing results required in the Special Controls document or an ISO Standard recognized by the US FDA. Since all the testing of performance needed to be presented in an Abbreviated 510k submission is in accordance with a previously accepted standard, the FDA reviewer only has to verify that the performance testing identified in the Special Controls document or the ISO Standard has been completed and acceptance criteria have been met. Now that the FDA requires 510k submissions to be submitted with the FDA eSTAR template, the advantages of Abbreviated 510k submissions has disappeared. In the future, this 510k case study may be a rare example where the FDA accepts Abbreviated 510k submissions.

In addition to Special Controls documents, the FDA also has guidance documents related to 510k submissions, such as: “Format for Traditional and Abbreviated 510(k)s.” By following this document verbatim, my client can avoid a lot of time-consuming questions from a reviewer that is having trouble finding the information they are looking for. If a section of the suggested format is not applicable, I still include this section. However, I indicate the reason why this section is not applicable in a brief paragraph (i.e., a one-page section).

As I read through the Special Controls Guidance document, I realized that a specific format for an Abbreviated 510k is described for topical adhesives. Therefore, I need to modify my normal template to match the FDA format for a topical adhesive Abbreviated 510k submission. As I read further, I realized that there would be some additional testing required that my client may not have anticipated. Product-specific testing is quite common and there are many other examples found in FDA special controls requirements in addition to this 510k case study.

In the Special Controls document, there are several risks and recommended mitigation measures identified:

The risks of adverse tissue reaction, chemical burns, and infection have all been addressed by biocompatibility testing and sterility testing. This 510k case study client also performed animal testing to identify any problems in a simulated use environment. However, the client did not perform any testing to address unintentional bonding specifically, wound dehiscence, applicator malfunction or delayed polymerization. The client needs verification protocols and test reports to address these specific risks.

Selection of a Primary Predicate

Another unique requirement from the US FDA for a 510k submission is the concept of a predicate device. A predicate device is a similar product that currently has a valid 510k. In July 2014, the US FDA released a guidance document that clarifies that companies submitting a 510k should identify only one primary predicate–rather than identifying multiple predicates. Ideally, a recent 510k submission should be selected because “old” technology may no longer be considered acceptable from a safety standpoint. In the case of topical adhesives, the applicator is one of the primary differences between legacy products and more recent 510k submissions. The most recent version of Surgiseal™ is an example of a new applicator for a monomeric, 2-octyl cyanoacrylate.

This 510k case study client has a similar applicator design, and therefore Surgiseal™ is selected as the primary predicate device for this 510k submission. For all the testing protocols that need to be created for this 510k submission, comparative testing is performed with a sample of Surgiseal™ and a sample of products made by my client. In each of these protocols, the acceptance criteria are performance “not worse than Surgiseal™.”

Additional 510k Training

If you enjoyed our 510k case study and you would like more 510k training, please search our website for more articles. We wrote a 510k book in 2017 when we first started hiring consultants to grow Medical Device Academy from an independent consulting business to a consulting firm. The book was called, “How to Prepare Your 510k in 100 Days.” Changes to the FDA 510k process have been rapid over the past 7 years, and the content is no longer relevant, but there is an on-line 510k course series consisting of 33 new FDA eSTAR webinars. You can also purchase our webinars individually.

510k Case Study – Part 1 Read More »

Feb 23 2015

Updates on Electrical Safety Standards for Medical Devices-IEC 60601

Leave a Comment / IEC 60601 / By Robert Packard / Electrical safety standards, IEC 60601, Medical device electrical standards, OSHA

This blog summarizes updates on electrical safety standards for medical devices-IEC 60601.

OSHA finally approved some Nationally Recognized Test Laboratories (NRTL) to AAMI ES 60601-1 (equivalent to IEC 60601-1 edition 3.1 or 3rd ed + A1). Leo Eisner posted a blog summarizing this change (http://bit.ly/OHSA-NRTL-Approval-Update) on January 7, 2015. The blog identifies which labs can issue NRTL Marks and which test labs have OSHA approval in progress. UL 60601-1 is still an approved standard that an approved NRTL can issue an NRTL test mark to, but a few of the NRTLs are now authorized to issue an NRTL Mark to AAMI ES 60601-1 3^rd edition + Amendment 1.

The best place to confirm if a Safety Test Lab is an approved NRTL for your medical device is by confirming the notifications published in the U.S. Federal Register. You can also visit the OSHA NRTL website (http://bit.ly/OSHA-NRTL), but the OSHA website is updated less frequently. Eventually, UL will formally announce the withdrawal of UL 60601-1, and OSHA will take steps to withdraw that Standard from their list of Approved Standards.

On January 14, 2015, Leo Eisner posted a second blog (http://bit.ly/IEC-60601-2-52-amd1-ed1) on the topic of IEC 60601-2-52 Medical beds as a pre-release. He discusses the actual changes between the 1st edition and 1st edition + A1. This version is the pre-release before the updated Standard is issued as an International Standard (IS), and it is currently available as a Final Draft International Standard (FDIS). IEC website (http://bit.ly/buy-IEC60601-2-52-amd1-ed1) states: “By purchasing this FDIS now, you will automatically receive, also, the final publication.” The voting period ended on February 13, 2015, and the FDIS should be published shortly after (forecasted to be published on March 27, 2015).

Leo’s blog summarizes each of the changes to the Standard. Among the changes, there is a specific requirement to include hazards related to patients taller than 185 cm (like me). These hazards should be included in the risk management file. The new symbols required to identify the requirements for an “adult” are below:

I find this new symbology particularly interesting because there are many medical devices where users frequently select the incorrect size for the patient. Consistent internationally recognized symbology for weight and height would be helpful for these devices, and bariatric specialty devices could benefit from the use of the last symbol.

If you need additional support for any of the IEC 60601 series of standards, please contact Rob Packard by email or phone (+1.802.281.4381) to discuss your specific needs.

Updates on Electrical Safety Standards for Medical Devices-IEC 60601 Read More »

Feb 19 2015

Good Documentation Practices (GDP 101) Webinar

Leave a Comment / ISO Certification / By Robert Packard

Medical Device Academy released a new webinar this week for training companies on good documentation practices.

Have you ever wondered where the FDA regulation is that says, “…shall not use white-out to correct quality system records.”

Don’t bother looking, because you won’t find it. You also won’t find any regulations against the use of red pens, highlighters, pencils, or markers. You can’t even find a guidance document that tells you not to put a single line through mistakes, initial and date it.

The applicable regulation is 21 CFR 820.180, but the regulation doesn’t specifically say these things. Instead, the regulation states: “Records shall be legible and shall be stored to minimize deterioration and to prevent loss.” The ISO 13485 Standard is not much different. It states that you must establish a procedure that will “Define the controls needed for the identification, storage, protection, retrieval, retention time and disposition of records.”

Over time medical device companies have developed some standard approaches to meet the requirements for Document Control, Control of Records, and Training. These are the three core processes that I call “good documentation practices.” If you need training or you need tools for training employees, click on the link below to purchase our new webinar on good documentation practices.

http://robertpackard.wpengine.com/good-documentation-practices-webinar/

The webpage also includes an exam for training people on good documentation practices. The exam serves as a useful check for the training, but we recommend that process owners monitor these processes–especially if the process is manual. For example, QC inspectors will complete inspection records and file the record as a quality system record. The QC supervisor, or process owner, should periodically review these records for completeness and accuracy. If the supervisor notices an error, the supervisor should notify the inspector and have them correct the mistake. The supervisor should also track how many times each error is made and specifically where errors are occurring. The collection of this data gives the supervisor trend data to help them identify which forms need to be updated to prevent mistakes and which employees require retraining. This data also provides evidence of competency for each employee concerning good documentation practices.

After you have completed the training, you might also be interested in downloading our procedures for Document Control, Control of Records and Training:

http://robertpackard.wpengine.com/standard-operating-procedures-medical-device-academy/

Good Documentation Practices (GDP 101) Webinar Read More »

Feb 11 2015

Auditing the Nonconforming Material Process-21 CFR 820.90-Part III

1 Comment / ISO Auditing / By Robert Packard / 21 CFR 820.90, Auditing 21 CFR 820.90, Auditing 820.90 nonconforming material process

This blog, “Auditing the Nonconforming Material Process-21 CFR 820.90,” identifies process interactions with the nonconforming material process.

Nonconforming material is not a “bad” thing in and of itself. Having no nonconformities is conspicuous. There are three critical aspects to verify when you are auditing nonconforming materials:

nonconforming materials are identified and segregated
disposition of nonconforming materials is appropriate
feedback from the nonconforming material process interacts with other processes

This article focuses on the third aspect–process interactions. The most efficient method for auditing process interactions is to use turtle diagrams because turtle diagrams provide a systematic framework for identifying process linkages (http://bit.ly/Process-Approach).

Turtle Diagram Step 1

The first step of completing a turtle diagram involves identifying the process owner and obtaining a brief description of the process. This typically will not lead directly to the identification of process interactions–unless the person being interviewed describes the process using a process flow diagram.

Turtle Diagram Step 2

The second step of completing a turtle diagram is where the auditor identifies inputs of raw materials and information to the process. For nonconforming materials, the key is to review the incoming inspection record and the trend of nonconformities from the supplier. In a thorough investigation of the root cause for nonconforming raw materials, an investigator may recalculate the process capability for each dimension to determine if the process capability has shifted since the original process validation by the supplier.

Turtle Diagram Step 3

In the third step of completing a turtle diagram, the auditor documents the flow of product and information when the process is done. The transfer from one process to another will often involve an in-process inspection and updating of the product status. The best practice is to identify these in-process inspection steps in a risk control plan as part of the overall process risk controls for product realization. Although risk control plans are not required in most companies, they will become more prevalent as companies update their quality systems to a risk-based process for compliance with the 2015 version of ISO 9001.

Turtle Diagram Step 4

The fourth step of the turtle diagram identifies calibration, maintenance, and validation that applies to the process of being audited. It is common for nonconformities to occur when measurement devices are out-of-calibration, or equipment is not adequately maintained. Therefore, auditors should always ask what device was used to measure a nonconformity, and what equipment was used to manufacture the product. Auditors should also review calibration and maintenance records for evidence that corrections are being made frequently.

Whenever frequent corrections are needed, the probability of devices being out-of-calibration and/or equipment malfunctioning increases. Auditors should also verify that the process parameters in use match the validated process parameters. Ideally, validation of process parameters is also directly linked to process risk analysis, and in-process inspections are performed whenever process capability is inadequate to ensure conforming parts. If an auditor observes a high frequency of nonconformities, then an in-process inspection should be implemented for containment, and the validation report should be compared to current process performance.

Turtle Diagram Step 5

The fifth step of completing a turtle diagram involves the identification of personnel and sampling training records. The procedure for control of nonconforming material should be required training for anyone responsible for initiating, investigating, or completing a nonconforming product record (i.e., NCR). Critical interactions to verify for effectiveness are related to process changes. If a procedure changes, training may need to be updated. An auditor should verify that there is a mechanism for tracking which revision of the procedure each person is trained to. In addition, training records should verify that training requirements are documented, training is effective, and that the person can demonstrate competency by correctly completing the sections of an NCR form. The auditor can review completed records to verify competency, but the auditor can also interview personnel and ask hypothetical questions.

Turtle Diagram Step 6

The sixth step of completing a turtle diagram involves the identification of all applicable controlled documents, such as procedures, work instructions, and forms. The auditor should also verify that the process for control of external standards is effective. In the case of controlling nonconforming product, there are seldom any applicable external standards. However, it is critical to verify that the current forms and NCR identification methods are being used for control of nonconforming product.

Turtle Diagram Step 7

The seventh and final step of the turtle diagram is data analysis of metrics and quality objectives for a process. For control of nonconforming product, there should be evidence of statistical analysis of the nonconforming product to identify the need for corrective actions. This is a requirement of 21 CFR 820.250. This data analysis should then be used to quantify process risks that may be used for decision-making and to explain those decisions during regulatory audits.

The above process interactions are just examples, and auditors may identify other essential process interactions during an audit. Each process interaction that touches a record of nonconforming product is a potential audit trail that could lead to value-added findings to prevent future nonconformities.

If you need help improving your process for controlling nonconforming product, or with auditing in general, please email Rob Packard.

Auditing the Nonconforming Material Process-21 CFR 820.90-Part III Read More »

Jan 27 2015

Complaint Investigation Case Study (21 CFR 820.198): Part 2

1 Comment / Complaint Handling / By Robert Packard

This article is part 2 of a two-part series specific to complaint investigation requirements as specified in 21 CFR 820.198 (http://bit.ly/21CFR820198) of FDA QSR. This second part explains how to perform a complaint investigation and provides a complaint investigation case study.

Last week’s blog reviewed the requirements for a complaint investigation, while this blog includes the following information on how to conduct an investigation:h

How thorough should your investigation be?
Investigation Methods
Verification of the Cause
Documenting Your Investigation
Complaint Investigation Case Study

How thorough should your investigation be?

The depth of investigation should be appropriate to the importance of the complaint. If a previous complaint of similar nature has already been investigated, the investigation may only gather enough information to verify that complaint has the same root cause. However, if a complaint involves an adverse event (i.e., is reportable under 21 CFR 803), then additional information needs to be recorded in the complaint record as per 21 CFR 820.198d:

Does the device fail to meet specifications?
Was the device used for treatment or diagnosis?
What was the relationship, if any, between the device and the reported event?

If the person gathering information from the complainant cannot immediately identify a cause code, or the incident involves a severe injury or death, then it is essential to collect as much information as possible. Typically, the complainant will be asked to return the device to determine if the device malfunctioned.

Investigation Methods

A complaint investigation is not any different from any investigation you perform for a CAPA. The most critical first step is to determine the cause of the complaint. To determine the cause, you need to sample additional records and inspect the device if it is available. If the device is not available, you might also look at other product from the same lot that remains in inventory. The following article I wrote suggests seven ways to investigate a complaint when a device is not returned: http://bit.ly/DeviceNotReturned.

One of the methods described in the article above is an Ishikawa Diagram or “Fishbone Diagram.” This is one of the five root cause analysis tools that I teach in my CAPA webinar (http://bit.ly/enKapCAPAwebinar). Ishikawa Diagrams are an ideal tool for root cause analysis if you have no idea what the cause of the complaint is because this tool provides a systematic process for narrowing down the potential causes, to the narrow few that are most likely. You are not required to use this tool, but you should describe in your complaint record what type of root cause analysis was performed.

Verification of Cause

Once you have identified the root cause, or at least narrowed your list to the most likely causes, you should then verify that the cause will result in the observed malfunction by recreating the scenario if possible. Ideally, you should be able to simulate the event that resulted in the complaint and demonstrate that you can reproduce the problem. This is important because if you cannot verify the cause of a device malfunction, then you will have difficulty verifying the effectiveness of corrective actions for an infrequent complaint.

Documenting Your Investigation

There is no specific format for the way a complaint investigation is documented. Still, most complaint records have a small section on the complaint form that allows them to write a short paragraph summarizing the investigation and the results. Unfortunately, most of the spaces provided on forms are completely inadequate for the amount of information that should be recorded. Therefore, the best approach is often to write, “See attached complaint investigation.” This is especially true if the complaint is reportable (i.e., requires MDR under 21 CFR 803). Good documentation is quantitative and specific. You need to identify which records were sampled as part of the investigation. You should demonstrate that you have expanded your initial search to determine if the problem exists in multiple production lots of the same product code, multiple product codes within the same product family and any other product families that may use similar raw materials, design features, equipment, testing methods or procedures.

Complaint Investigation Case Study

If your company manufactures cast orthopedic implants for the knee and you receive a complaint about an implant that has a small imperfection in the bearing surface of the femoral implant, you may need to perform an investigation–especially if this has not occurred previously. You should request a return of the implant for inspection to verify that the imperfection is nonconforming and not just a cosmetic defect.

Your investigation should include a review of the lot history record for an entire lot of implants–as well as any other parts that they may have been cast at the same time. All the process conditions identified throughout the manufacturing process should be compared to the validated process parameters. Special attention should be given to the inspection results that were recorded for the castings (i.e., radiographic inspection, fluorescent penetrant inspection, and metallurgical inspection). Ideally, these inspection methods should be repeated for 100% of the production lot to ensure that the inspection results meet the acceptance criteria. Documentation of the investigation should include copies of all records that were reviewed and photos if visual inspections were repeated.

If you are interested in learning more about complaint handling, you might be interested in downloading the webinar that Medical Device Academy recorded last year for complaint handling and vigilance reporting (http://bit.ly/Complaint-Webinar-Landing). We can also help you one-on-one with a current complaint investigation you are conducting. Please don’t hesitate to contact me. Mobile: 802.281.4381 or rob@13485cert.com.

Complaint Investigation Case Study (21 CFR 820.198): Part 2 Read More »