K Number
K162381

Validate with FDA (Live)

Date Cleared
2017-01-31

(160 days)

Product Code
Regulation Number
880.6250
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

A powder-free patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

In addition, these gloves were tested for use with the following chemotherapy drugs at specific concentrations as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

The gloves have been tested with the following drugs and the respective breakthrough detection times are listed below.

No.Chemotherapy Drugs and ConcentrationsBreakthrough
1.Blenoxane (15 mg/ml)> 240 minutes
2.Busulfan (6 mg/ml)> 240 minutes
3.Carboplatin (10 mg/ml)> 240 minutes
4.Carmustine (BCNU) (3.3 mg/ml)*30.4 minutes
5.Cisplatin (1.0 mg/ml)> 240 minutes
6.Cyclophosphamide (Cytoxan) (20 mg/ml)> 240 minutes
7.Cytarabine (100 mg/ml)> 240 minutes
8.Dacarbazine (DTIC) (10.0 mg/ml)> 240 minutes
9.Daunorubicin (5 mg/ml)> 240 minutes
10.Docetaxel (10.0 mg/ml)> 240 minutes
11.Doxorubicin Hydrochloride (2.0 mg/ml)> 240 minutes
12.Ellence (2 mg/ml)> 240 minutes
13.Etoposide (Toposar) (20.0 mg/ml)> 240 minutes
14.Fludarabine (25 mg/ml)> 240 minutes
15.Fluorouracil (50.0 mg/ml)> 240 minutes
16.Ganciclovir (10 mg/ml)> 240 minutes
17.Gemcitabine (Gemzar) (38 mg/ml)> 240 minutes
18.Idarubicin (1 mg/ml)> 240 minutes
19.Ifosfamide (50.0 mg/ml)> 240 minutes
20.Irinotecan (20.0 mg/ml)> 240 minutes
21.Mechlorethamine HCl (1.0 mg/ml)> 240 minutes
22.Melphalan (5 mg/ml)> 240 minutes
23.Methotrexate (25 mg/ml)> 240 minutes
24.Mitoxantrone (2.0mg/ml)> 240 minutes
25.Mitomycin C (0.5 mg/ml)> 240 minutes
26.Oxaliplatin (5 mg/ml)> 240 minutes
27.Paclitaxel (Taxol) (6.0 mg/ml)> 240 minutes
28.Rituximab (10 mg/ml)> 240 minutes
29.Thiotepa (10.0 mg/ml)> 240 minutes
30.Trisenox (0.1 mg/ml)> 240 minutes
31.Vincristine Sulfate (1.0 mg/ml)> 240 minutes
32.Vinorelbine (10 mg/ml)> 240 minutes
Device Description

Nitrile Powder Free Examination Gloves Tested for Use with Chemotherapy Drugs are non-sterile, lavender blue colored, powder-free, ambidextrous patient examination glove that meets the specifications of ASTM D 6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application. In addition these gloves were tested for use with the Chemotherapy drugs listed in the Intended Use(s) section below, as per ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs.

These gloves meet the 2008 Glove Guidance Manual recommended minimum thickness and length specifications for gloves tested for use with chemotherapy drugs.

AI/ML Overview

This document describes the "HG PRO XP® Nitrile Powder Free Examination Gloves Tested For Use with Chemotherapy Drugs" and its substantial equivalence to a predicate device (K113423). The study primarily focuses on non-clinical performance data, specifically addressing the glove's resistance to permeation by chemotherapy drugs and other physical and biological properties.

Here's an analysis of the acceptance criteria and the study that proves the device meets them:

1. A table of acceptance criteria and the reported device performance:

The document provides a comprehensive side-by-side comparison in "Table 1. Side-by-Side Comparison of Predicate Device with Subject Device: Indications for Use, Non-clinical Performance Data and Technological Characteristics" (pages 7-8).

CharacteristicsAcceptance Criteria/StandardsSubject Device Performance
Primary Indication for UseMedical Gloves Guidance ManualA powder-free patient Examination Gloves is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.
Additional Indication (Chemo Drugs)ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy DrugsBreakthrough Detection Time (min) for various chemotherapy drugs: - Blenoxane (15 mg/ml): > 240 min - Busulfan (6 mg/ml): > 240 min - Carboplatin (10 mg/ml): > 240 min - Carmustine (BCNU) (3.3 mg/ml): 30.4 min - Cisplatin (1.0 mg/ml): > 240 min - Cyclophosphamide (Cytoxan) (20 mg/ml): > 240 min - Cytarabine (100 mg/ml): > 240 min - Dacarbazine (DTIC) (10.0 mg/ml): > 240 min - Daunorubicin (5 mg/ml): > 240 min - Docetaxel (10.0 mg/ml): > 240 min - Doxorubicin Hydrochloride (2.0 mg/ml): > 240 min - Ellence (2 mg/ml): > 240 min - Etoposide (Toposar) (20.0 mg/ml): > 240 min - Fludarabine (25 mg/ml): > 240 min - Fluorouracil (50.0 mg/ml): > 240 min - Ganciclovir (10 mg/ml): > 240 min - Gemcitabine (Gemzar) (38 mg/ml): > 240 min - Idarubicin (1 mg/ml): > 240 min - Ifosfamide (50.0 mg/ml): > 240 min - Irinotecan (20.0 mg/ml): > 240 min - Mechlorethamine HCl (1.0 mg/ml): > 240 min - Melphalan (5 mg/ml): > 240 min - Methotrexate (25 mg/ml): > 240 min - Mitoxantrone (2.0 mg/ml): > 240 min - Mitomycin C (0.5 mg/ml): > 240 min - Oxaliplatin (5 mg/ml): > 240 min - Paclitaxel (Taxol) (6.0 mg/ml): > 240 min - Rituximab (10 mg/ml): > 240 min - Thiotepa (10.0 mg/ml): > 240 min - Trisenox (0.1 mg/ml): > 240 min - Vincristine Sulfate (1.0 mg/ml): > 240 min - Vinorelbine (10 mg/ml): > 240 min *Noted extremely low permeation time: Carmustine (BCNU) (3.3 mg/ml) at 30.4 minutes.
MaterialASTM D6319-10Nitrile Synthetic Rubber
Color-Lavender Blue
Texture-Textured Fingers
SizeMedical Glove Guidance Manual-Labeling- Issued on January 22, 2008Extra Small, Small, Medium, Large, Extra Large
Single UseMedical Gloves Guidance Manual -Issued on January 22, 2008Single use
DimensionASTM D6319-10Meets ASTM D6319-10 (Length: 270 mm minimum, Palm Widths for various sizes provided)
ThicknessASTM D6319-10Meets ASTM D6319-10 (Finger: 0.10 mm minimum, Palm: 0.10 mm minimum)
Physical PropertiesASTM D6319-10Meet ASTM D6319-10 (Tensile Strength: 14 MPa min (before & after aging), Ultimate Elongation: 500% min (before aging), 400% min (after aging))
Watertight testASTM D5151-06Pass AQL 1.5
Residual PowderASTM D6124-06Meet (< 2.0 mg/glove)
BiocompatibilityPrimary Skin Irritation - ISO 10993-10: 2010Pass (Not a primary skin irritant under the conditions of the study)
BiocompatibilityDermal Sensitization - ISO 10993-10: 2010Pass (Not a contact sensitizer under the conditions of the study)

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective):

  • Sample Size: The document does not explicitly state the sample size (e.g., number of gloves) used for each specific test (e.g., watertight, chemotherapy permeation). It refers to compliance with standards like ASTM D6319-10, ASTM D5151-06, ASTM D6124-06, ISO 10993-10:2010, and ASTM D6978-05, which would typically specify the required sample sizes for testing. For example, for the watertight test, it states "Pass AQL 1.5," which implies statistical sampling and testing according to the ASTM D5151-06 standard.
  • Data Provenance: The manufacturer is "Healthy Glove Co., Ltd" from Hatyai, Songkhla, Thailand (page 4). The data itself is "non-clinical performance data" (page 10) generated to show substantial equivalence to a predicate device. It is prospective testing conducted by the manufacturer or contracted labs to meet regulatory requirements.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience):

This type of information is not applicable to this submission. The device is a patient examination glove, and the "ground truth" is established by adherence to recognized international and national standards (ASTM, ISO) for material properties, physical performance, biocompatibility, and chemical resistance. These standards define objective test methods and acceptance criteria, rather than relying on expert human interpretation of complex medical imagery or clinical outcomes.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

None. Adjudication methods like 2+1 or 3+1 are typically used in studies involving expert interpretation (e.g., medical imaging reads) where discrepancies need to be resolved. For objective physical and chemical testing of medical gloves, the results are quantitative or pass/fail based on the defined test methodologies of the respective ASTM and ISO standards.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

No. This device is a medical glove, not an AI-powered diagnostic or interpretive tool. Therefore, a multi-reader multi-case (MRMC) comparative effectiveness study or assessment of human reader improvement with AI assistance is not relevant or applicable.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done:

Not applicable. This device is a physical product (medical glove), not an algorithm or software. Standalone performance for an algorithm is not relevant here. The "standalone" performance here refers to the glove's inherent properties and performance tested against predefined standards.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc):

The "ground truth" for this device is based on accepted industry standards and test methods. Specifically:

  • Physical properties (dimensions, thickness, tensile strength, elongation) are compared against ASTM D6319-10.
  • Watertight integrity is assessed per ASTM D5151-06.
  • Residual powder is measured per ASTM D6124-06.
  • Biocompatibility (skin irritation and sensitization) is tested according to ISO 10993-10:2010.
  • Resistance to chemotherapy drug permeation is tested according to ASTM D6978-05.

These standards define the methodologies and the acceptable ranges for performance, serving as the objective "ground truth."

8. The sample size for the training set:

Not applicable. There is no "training set" in the context of this device. Training sets are relevant for machine learning algorithms. The glove manufacturer produces the gloves, and then specific samples are tested for compliance with standards. There's no iterative learning or model training involved.

9. How the ground truth for the training set was established:

Not applicable. As there is no training set, this question is not relevant. The "ground truth" for evaluating the glove's performance against its acceptance criteria is established by the test protocols within the cited ASTM and ISO standards.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized caduceus or a series of interconnected human profiles.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

January 31, 2017

Healthy Glove Co., Ltd Teoh Shee Managing Director 119 Kanchanavanich Road, Tambol Patong Hatyai, Songkhla, Thailand 90230

Re: K162381

Trade/Device Name: HG PRO XP® Nitrile Powder Free Examination Gloves Tested For Use with Chemotherapy Drugs Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LZA, LZC Dated: November 28, 2016 Received: December 5, 2016

Dear Teoh Shee:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. 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 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 (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely,

Michael J. Ryan -S

for Tina Kiang, Ph.D.

Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Form Approved: OMB No. 0910-0120

Expiration Date: January 31, 2017

See PRA Statement below.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K162381

Device Name

HG PRO® XP Nitrile Powder Free Examination Gloves Tested for Use with Chemotherapy Drugs

Indications for Use (Describe)

A powder-free patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

In addition, these gloves were tested for use with the following chemotherapy drugs at specific concentrations as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

The gloves have been tested with the following drugs and the respective breakthrough detection times are listed belov.

No.Chemotherapy Drugs and ConcentrationsBreakthrough
1.Blenoxane (15 mg/ml)> 240 minutes
2.Busulfan (6 mg/ml)> 240 minutes
3.Carboplatin (10 mg/ml)> 240 minutes
4.Carmustine (BCNU) (3.3 mg/ml)*30.4 minutes
5.Cisplatin (1.0 mg/ml)> 240 minutes
6.Cyclophosphamide (Cytoxan) (20 mg/ml)> 240 minutes
7.Cytarabine (100 mg/ml)> 240 minutes
8.Dacarbazine (DTIC) (10.0 mg/ml)> 240 minutes
9.Daunorubicin (5 mg/ml)> 240 minutes
10.Docetaxel (10.0 mg/ml)> 240 minutes
11.Doxorubicin Hydrochloride (2.0 mg/ml)> 240 minutes
12.Ellence (2 mg/ml)> 240 minutes
13.Etoposide (Toposar) (20.0 mg/ml)> 240 minutes
14.Fludarabine (25 mg/ml)> 240 minutes
15.Fluorouracil (50.0 mg/ml)> 240 minutes
16.Ganciclovir (10 mg/ml)> 240 minutes
17.Gemcitabine (Gemzar) (38 mg/ml)> 240 minutes
18.Idarubicin (1 mg/ml)> 240 minutes
19.Ifosfamide (50.0 mg/ml)> 240 minutes
20.Irinotecan (20.0 mg/ml)> 240 minutes
21.Mechlorethamine HCl (1.0 mg/ml)> 240 minutes
22.Melphalan (5 mg/ml)> 240 minutes
23.Methotrexate (25 mg/ml)> 240 minutes
24.Mitoxantrone (2.0mg/ml)> 240 minutes
25.Mitomycin C (0.5 mg/ml)> 240 minutes
26.Oxaliplatin (5 mg/ml)> 240 minutes
27.Paclitaxel (Taxol) (6.0 mg/ml)> 240 minutes
28.Rituximab (10 mg/ml)> 240 minutes
29.Thiotepa (10.0 mg/ml)> 240 minutes
30.Trisenox (0.1 mg/ml)> 240 minutes
31.Vincristine Sulfate (1.0 mg/ml)> 240 minutes
32.Vinorelbine (10 mg/ml)> 240 minutes

Detection Time in Minutes

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  • Please note that the following drug has extremely low permeation time: Carmustine (BCNU) (3.3 mg/ml) at 30.4 minutes

Type of Use (Select one or both, as applicable)

J Prescription Use (Part 21 CFR 801 Subpart D)

Z Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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Image /page/4/Picture/1 description: The image shows a logo for the "SRITONG GROUP". The logo consists of two overlapping shapes: a pink circle on the left and a white hexagon on the right. Inside the pink circle are four horizontal white lines. Inside the white hexagon are the letters "H" and "G" in blue.

HEALTHY GLOVE CO., LTD. 119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand Tel: +66 74 536 815 Fax: +66 74 536 816

510(k) SUMMARY Nitrile Powder Free Examination Gloves Tested for Use with Chemotherapy Drugs

1.0 Submitter:

Applicant:Healthy Glove Co., Ltd119 Kanchanavanich Road, Tambol PatongHat Yai, Songkhla 90230Thailand
Phone Number:+66 74 536 815
Fax Number:+66 74 536 816
Name of Contact Person:Choh-Shee Teoh (Mr)
Preparation date:November 24, 2016

2.0 Name of Subject Device:

Trade/Proprietary Name(s):HG PRO® XP Nitrile Powder Free Examination Gloves Tested for Usewith Chemotherapy Drugs
Common Name:Nitrile Powder Free Examination Gloves Tested for Use withChemotherapy Drugs
Classification Name:Patient Examination Gloves (21 CFR 880.6250)
Device Class:I
Product Code:LZA, LZC

3.0 Identification of The Legally Marketed Devices that equivalency is claimed

Manufacturer:Kimberly Clark Corporation
Device Name:PURPLE NITRILE-XTRA* Powder-Free Exam - 12' Length
510(k):K113423
Regulatory Class:I
Classification Name:Patient Examination Gloves (21 CFR 880.6250)
Product Code:LZA, LZC

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Image /page/5/Picture/0 description: The image shows a logo for the "SRITONG GROUP". The logo consists of two overlapping shapes: a pink circle on the left with horizontal lines inside, and a white hexagon on the right with the letters "HG" in blue. The text "SRITONG GROUP" is written in a bold, blue font below the logo.

4.0 Description of the Device:

Nitrile Powder Free Examination Gloves Tested for Use with Chemotherapy Drugs are non-sterile, lavender blue colored, powder-free, ambidextrous patient examination glove that meets the specifications of ASTM D 6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application. In addition these gloves were tested for use with the Chemotherapy drugs listed in the Intended Use(s) section below, as per ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs.

These gloves meet the 2008 Glove Guidance Manual recommended minimum thickness and length specifications for gloves tested for use with chemotherapy drugs.

5.0 Intended Use of the Device:

A powder-free patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

In addition, these gloves were tested for use with the following chemotherapy drugs at specific concentrations as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

The gloves have been tested with the following drugs and the respective breakthrough detection times are listed below.

No.Chemotherapy DrugsConcentrationBreakthrough detection timein Minutes
1.Blenoxane15 mg/ml>240 min
2.Busulfan6 mg/ml>240 min
3.Carboplatin10 mg/ml>240 min
4.Carmustine (BCNU) *3.3 mg/ml30.4 min
5.Cisplatin1.0 mg/ml>240 min
6.Cyclophosphamide (Cytoxan)20 mg/ml>240 min
7.Cytarabine100 mg/ml>240 min
8.Dacarbazine (DTIC)10.0 mg/ml>240 min
9.Daunorubicin5 mg/ml>240 min
10.Docetaxel10.0 mg/ml>240 min
11.Doxorubicin Hydrochloride2.0 mg/ml>240 min
12.Ellence2 mg/ml>240 min
13.Etoposide (Toposar)20.0 mg/ml>240 min
14.Fludarabine25 mg/ml>240 min
15.Fluorouracil50.0 mg/ml>240 min
16.Ganciclovir10 mg/ml>240 min
17.Gemcitabine (Gemzar)38 mg/ml>240 min
18.ldarubicin1 mg/ml>240 min

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Image /page/6/Picture/0 description: The image shows a logo with two pink circles overlapping each other. The left circle contains four horizontal white lines. The right circle contains a white hexagon with the letters "HG" in blue. The text "SRITONG GROUP" is below the logo.

HEALTHY GLOVE CO., L

119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand Tel: +66 74 536 815 Fax: +66 74 536 816

SRITONG GROUP

No.Chemotherapy DrugsConcentrationBreakthrough detection timein Minutes
19.Ifosfamide50.0 mg/ml>240 min
20.Irinotecan20.0 mg/ml>240 min
21.Mechlorethamine HCl1.0 mg/ml>240 min
22.Melphalan5 mg/ml>240 min
23.Methotrexate25 mg/ml>240 min
24.Mitoxantrone2.0mg/ml>240 min
25.Mitomycin C0.5 mg/ml>240 min
26.Oxaliplatin5 mg/ml>240 min
27.Paclitaxel (Taxol)6.0 mg/ml>240 min
28.Rituximab10 mg/ml>240 min
29.Thiotepa10.0 mg/ml>240 min
30.Trisenox0.1 mg/ml>240 min
31.Vincristine Sulfate1.0 mg/ml>240 min
32.Vinorelbine10 mg/ml>240 min

6.0 Summary of Technological Characteristics Compared to the Predicate Device:

There are no different technological characteristics of the Subject Device compared to the Predicate Device.

Nitrile Powder Free Examination Gloves Tested for Use with Chemotherapy Drugs are summarized with the following technological characteristics compared to ASTM D 6319 or equivalent standards as shown in Table 1.

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Image /page/7/Picture/0 description: The image shows a logo for the "SRITONG GROUP". The logo consists of two overlapping pink circles. The left circle contains horizontal white lines, and the right circle contains a white hexagon with the letters "HG" in blue. The text "SRITONG GROUP" is written in blue below the logo.

HEALTHY GLOVE CO., LTD. 119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand
Tel: +66 74 536 815 Fax: +66 74 536 816

Table 1. Side-by-Side Comparison of Predicate Device with Subject Device:

Indications for Use, Non-clinical Performance Data and Technological Characteristics

CharacteristicsAcceptanceCriteria/StandardsPredicate Device:510K No: 113423Non-Sterile, Powder Free NitrileExamination glove, Tested foruse with Chemotherapy drugsper ASTM D6978-05Subject Device:(New 510(k) submission)Non-Sterile, Powder Free NitrileExamination glove, Tested for usewith Chemotherapy drugs perASTM D6978-05
Manufacturer(s)Kimberly Clark CorporationHealthy Glove Co., Ltd
Indications for UseMedical Gloves GuidanceManualA powder-free patientExamination Gloves is adisposable device intended formedical purposes that is wornon the examiner's hand or fingerto prevent contaminationbetween patient and examinerA powder-free patientExamination Gloves is adisposable device intended formedical purposes that is worn onthe examiner's hand or finger toprevent contamination betweenpatient and examiner
MaterialASTM D6319-10Nitrile Synthetic RubberNitrile Synthetic Rubber
ColorPurpleLavender Blue
TextureTextured FingersTextured Fingers
SizeMedical Glove GuidanceManual-Labeling- Issuedon January 22, 2008Extra SmallSmallMediumLargeExtra LargeExtra SmallSmallMediumLargeExtra Large
Single UseMedical Gloves GuidanceManual -Issued onJanuary 22, 2008Single useSingle use
CharacteristicsAcceptanceCriteria/StandardsPredicate Device:510K No: 113423Non-Sterile, Powder Free NitrileExamination glove, Tested foruse with Chemotherapy drugsper ASTM D6978-05Subject Device:(New 510(k) submission)Non-Sterile, Powder Free NitrileExamination glove, Tested foruse with Chemotherapy drugsper ASTM D6978-05
DimensionASTM D6319-10Meets ASTM D6319-10Meets ASTM D6319-10
Length : 270 mm minimum
Palm Width
Extra Small = 70 +10 mmSmall = 80 +10 mmMedium = 95 +10 mmLarge = 110 +10 mmExtra Large = 120 ±10 mm
ThicknessASTM D6319-10Meets ASTM D6319-10Meets ASTM D6319-10
Finger: 0.10 mm minimum
Palm: 0.10 mm minimum
Physical PropertiesASTM D6319-10Meet ASTM D6319-10Meet ASTM D6319-10
Tensile Strength:
14 MPa min (before aging)
14 MPa min (after aging)
Ultimate Elongation:
500% min (before aging)
400% min (after aging)
Watertight test(1000 ml)ASTM D5151-06PassPass AQL 1.5
Residual PowderASTM D6124-06Meet< 2.0 mg/gloveMeet< 2.0 mg/glove
BiocompatibilityPrimary Skin Irritation -ISO 10993-10: 2010PassPassNot a primary skin irritant underthe conditions of the study
Dermal Sensitization -ISO 10993-10: 2010PassPassNot a contact sensitizer underthe conditions of the study
CharacteristicsAcceptanceCriteria/StandardsPredicate Device:510K No: 113423Non-Sterile, Powder FreeNitrile Examination glove,Tested for use withChemotherapy drugs perASTM D6978-05Subject Device:(New 510(k) submission)Non-Sterile, Powder FreeNitrile Examination glove,Tested for use withChemotherapy drugs perASTM D6978-05
Resistance againstChemotherapy DrugsASTM D6978-05(2013)Breakthrough Detection Time (min)
Blenoxane(15 mg/ml)Not tested> 240 min
Busulfan(6 mg/ml)> 240 min> 240 min
Carboplatin(10 mg/ml)> 240 min> 240 min
Carmustine (BCNU) *(3.3 mg/ml)30.7 min30.4 min
Cisplatin(1.0 mg/ml)> 240 min> 240 min
Cyclophosphamide(Cytoxan)(20 mg/ml)> 240 min> 240 min
Cytarabine100 mg/ml> 240 min> 240 min
Dacarbazine (DTIC)(10.0 mg/ml)> 240 min> 240 min
Daunorubicin(5 mg/ml)> 240 min> 240 min
Docetaxel(10.0 mg/ml)> 240 min> 240 min
DoxorubicinHydrochloride(2.0 mg/ml)> 240 min> 240 min
Ellence(2 mg/ml)> 240 min> 240 min
Etoposide (Toposar)(20.0 mg/ml)> 240 min> 240 min
Fludarabine(25 mg/ml)> 240 min> 240 min
Fluorouracil(50.0 mg/ml)> 240 min> 240 min
Ganciclovir(10 mg/ml)Not tested> 240 min
Gemcitabine (Gemzar)(38 mg/ml)> 240 min> 240 min
Idarubicin(1 mg/ml)> 240 min> 240 min
Ifosfamide(50.0 mg/ml)> 240 min> 240 min
Irinotecan(20.0 mg/ml)> 240 min> 240 min
Mechlorethamine HCl(1.0 mg/ml)> 240 min> 240 min
CharacteristicsAcceptanceCriteria/StandardsPredicate Device:510K No: 113423Non-Sterile, Powder FreeNitrile Examination glove,Tested for use withChemotherapy drugs perASTM D6978-05Subject Device:(New 510(k) submission)Non-Sterile, Powder FreeNitrile Examination glove,Tested for use withChemotherapy drugs perASTM D6978-05
Resistance againstChemotherapy DrugsASTM D6978-05(2013)Breakthrough Detection Time (min)
Melphalan(5 mg/ml)> 240 min> 240 min
Methotrexate(25 mg/ml)> 240 min> 240 min
Mitoxantrone(2.0mg/ml)> 240 min> 240 min
Mitomycin C(0.5 mg/ml)> 240 min> 240 min
Oxaliplatin(5 mg/ml)Not tested> 240 min
Paclitaxel (Taxol)(6.0 mg/ml)> 240 min> 240 min
Rituximab(10 mg/ml)> 240 min> 240 min
Thiotepa(10.0 mg/ml)> 240 min> 240 min
Trisonex(0.1 mg/ml)> 240 min> 240 min
Vincristine Sulfate(1.0 mg/ml)> 240 min> 240 min
Vinorelbine(10 mg/ml)Not tested> 240 min
Please note that the followingdrug has extremely lowpermeation times:*Please note that thefollowing drug has extremelylow permeation times:
Carmustine (BCNU) (3.3mg/ml) 30.7 minutesCarmustine (BCNU) (3.3mg/ml) at 30.4 minutes

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Image /page/8/Picture/0 description: The image shows a logo for the Sritong Group. The logo consists of two pink circles, one containing horizontal lines and the other containing the letters "HG" in blue. The text "SRITONG GROUP" is written in blue below the logo.

HEALTHY GLOVE CO., LTD.

119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand
Tel: +66 74 536 815 Fax: +66 74 536 816

{9}------------------------------------------------

Image /page/9/Picture/0 description: The image shows a logo for SRITONG GROUP. The logo consists of two pink circles that are overlapping. The left circle contains four horizontal white lines. The right circle contains a white hexagon with the letters 'HG' in blue. The text 'SRITONG GROUP' is located below the logo.

HEALTHY GLOVE CO., LTD.

119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand
Tel: +66 74 536 815 Fax: +66 74 536 816

SRITONG GROUP

{10}------------------------------------------------

Image /page/10/Picture/0 description: The image shows a logo for the "SRITONG GROUP". The logo consists of two pink circles, one containing horizontal lines and the other containing the letters "HG" in blue. The text "SRITONG GROUP" is written in blue below the logo.

HEALTHY GLOVE CO.,

119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand Tel: +66 74 536 815 Fax: +66 74 536 816

7.0 Substantial Equivalent Based on Assessment of Non-clinical Performance Data:

The performance test data of the non-clinical tests that support a determination of substantial equivalence is the same as mentioned in the previous section (ASTM Requirements).

8.0 Substantial Equivalent Based on Assessment of Clinical Performance Data:

No clinical testing was required to determine substantial equivalence of this device.

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Image /page/11/Picture/0 description: The image shows a logo for the "SRITONG GROUP". The logo consists of two pink circles, one containing horizontal lines and the other containing the letters "HG" inside of a hexagon. The text "SRITONG GROUP" is written in blue below the logo.

HEALTHY GLOVE CO., LTD. 119 Kanchanavanich Road, T. Patong, Hatyai, Songkhla 90230, Thailand Tel: +66 74 536 815 Fax: +66 74 536 816

9.0 Conclusion:

Based on the comparison of the intended use, technological characteristics and non-clinical performance test data, the subject device, Nitrile Powder Free Examination Glove Tested for Use with Chemotherapy Drugs is substantially equivalent to the Predicate Device K113423.

§ 880.6250 Non-powdered patient examination glove.

(a)
Identification. A non-powdered patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. A non-powdered patient examination glove does not incorporate powder for purposes other than manufacturing. The final finished glove includes only residual powder from manufacturing.(b)
Classification. Class I (general controls). The device, when it is a finger cot, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 880.9.