K Number
K220697

Validate with FDA (Live)

Date Cleared
2022-09-15

(190 days)

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

Nitrile Patient Examination Gloves, Powder Free, are intended for medical purposes that are worn on the examiners' hands to prevent contamination between patient and examiner.

Device Description

The Nitrile Patient Examination Gloves, Powder Free are non-sterile, single use only, disposable, and powder free examination gloves. The glove is made of synthetic nitrile latex compound. The device is ambidextrous and can be worn on either the left or right hand. The device meets ASTM D 6319 - Standard specification for Nitrile Examination Gloves for Medical Application.

AI/ML Overview

This document is a 510(k) Premarket Notification for Nitrile Patient Examination Gloves, Powder Free. It demonstrates the substantial equivalence of the proposed device to a legally marketed predicate device (Primus Nitrile Examination Gloves, K143477).

Here's the breakdown of the acceptance criteria and study information:

1. Table of Acceptance Criteria and Reported Device Performance

Device: Nitrile Patient Examination Gloves, Powder Free (Lalan Rubbers (Pvt) Ltd)

CharacteristicAcceptance Criteria (Predicate Device / ASTM D6319)Reported Device Performance (Nitrile Patient Examination Gloves, Powder Free)
Physical Characteristics:ASTM D6319 requirementsMeets ASTM D6319 requirements
LengthMinimum 230mmMinimum 240mm
Palm width (XS)$70 \pm 10$$\leq 80$
Palm width (S)$80 \pm 10$$85 \pm 5$
Palm width (M)$95 \pm 10$$95 \pm 5$
Palm width (L)$110 \pm 10$$105 \pm 5$
Palm width (XL)$120 \pm 10$$\geq 110$
Thickness (Finger)Minimum 0.05mm$0.09 \pm 0.01$mm
Thickness (Palm)Minimum 0.05mm$0.07 \pm 0.01$mm
Thickness (Cuff)Not explicitly defined (implied by ASTM)$0.05 \pm 0.01$mm
Physical Properties:ASTM D6319 requirements for tensile strength and ultimate elongationMeets ASTM D6319 requirements
Tensile Strength (Before Aging)Minimum 14 MPaMinimum 14 MPa
Tensile Strength (After Aging)Minimum 14 MPaMinimum 14 MPa
Ultimate Elongation (Before Aging)Minimum 500%Minimum 500%
Ultimate Elongation (After Aging)Minimum 400%Minimum 400%
Freedom from holes:ASTM D6319 requirements of GI, AQL 2.5Meets ASTM D6319 and ASTM D5151 requirements of AQL 2.5
Powder Residual:ASTM D6319 requirements; Not more than 2.0mg/gloveMeets applicable requirement for powder free; $\leq$ 2 mg per glove
Biocompatibility:ASTM and ISO standards-
Skin Irritation TestNot an irritant (Under predicate study conditions)Under the conditions of the study, not an irritant (ISO10993-23:2021)
Skin Sensitization TestNot a sensitizer (Under predicate study conditions)Under the conditions of the study, not a sensitizer (ISO 10993-10:2010)
In Vitro CytotoxicityNot explicitly stated for predicateDiluted concentrations 12.5% and 6.25% are not cytotoxic. Undiluted extract (100%), diluted concentrations 50% & 25% are cytotoxic. (ISO 10993-5:2009)
Acute Systemic ToxicityNot explicitly stated for predicateUnder the conditions of the study, no evidence of systemic toxicity (ISO 10993-11: 2017)
Shelf Life3 years3 years (EN, 455-4:2009)

2. Sample size used for the test set and the data provenance

The document specifies that non-clinical tests were conducted to verify that the proposed subject device met all design specifications. The sample sizes for each specific test (e.g., number of gloves for physical testing, number of samples for biocompatibility) are not explicitly provided in this summary document. However, the tests are performed according to recognized international standards (ASTM and ISO), which typically specify appropriate sample sizes and methodologies.

The "data provenance" (country of origin, retrospective/prospective) is not detailed for the test samples, but the tests were performed by Lalan Rubbers (Pvt) Ltd in Sri Lanka, which is the manufacturer. The tests are prospective in nature, as they involve testing newly manufactured devices against established standards.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This device (Nitrile Patient Examination Gloves) does not involve expert interpretation or clinical diagnosis that would require human "ground truth" establishment in the typical sense of AI/clinical decision support systems. The "ground truth" here is objective measurement against established physical and chemical standards (ASTM D6319, ISO 10993 series). Therefore, there were no "experts" establishing a subjective ground truth for a test set in this context. The acceptance criteria are quantitative and based on published standards.

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

Not applicable. As noted above, the "ground truth" is objective measurement against established physical and chemical standards. There is no subjective interpretation requiring adjudication.

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

Not applicable. This device is a medical glove, not an AI-assisted diagnostic or clinical decision support system that involves human readers interpreting cases.

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

Not applicable. This is not an algorithm or AI device. The tests performed are for the physical, chemical, and biological properties of the glove itself.

7. The type of ground truth used

The ground truth used for this device's performance evaluation against acceptance criteria is objective measurement against recognized international standards and specifications. Specifically:

  • Physical and Dimensional Properties: ASTM D6319 (Standard Specification for Nitrile Examination Gloves for Medical Application)
  • Freedom from holes: ASTM D6319 and ASTM D5151 (Standard Test Method for Detection of Holes in Medical Gloves)
  • Powder Residual: ASTM D6319 and ASTM D6124 (Standard Test Method for Residual Powder on Medical Gloves)
  • Biocompatibility: ISO 10993-10, ISO 10993-23, ISO 10993-11, ISO 10993-5 (Biological evaluation of medical devices for irritation, sensitization, systemic toxicity, and cytotoxicity)
  • Shelf Life: EN 455-4:2009 (Medical gloves for single use Part 4: Requirements and testing for shelf life determination)

8. The sample size for the training set

Not applicable. This product is not an AI/machine learning model, so there is no concept of a "training set" in this context. The design and manufacturing process for the gloves are developed based on general engineering and material science principles, and then verified through the non-clinical tests mentioned.

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

Not applicable, as there is no training set for this device.

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Image /page/0/Picture/0 description: The image shows the logo for the U.S. Food & Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the FDA name on the right. The symbol is a stylized representation of a human figure, while the FDA name is written in blue and includes the words "U.S. Food & Drug Administration".

September 15, 2022

Lalan Rubbers (Pvt) Ltd Renuka Priyangi Manager - Quality Assurance No.95/B, Zone A, Export Processing Zone, Biyagama Malwana, Western EPZ 11672 Sri Lanka

Re: K220697

Trade/Device Name: Nitrile Patient Examination Gloves, Powder Free Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LZA Dated: June 29, 2022 Received: August 26, 2022

Dear Renuka Priyangi:

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

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

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

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

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

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Bifeng Qian, M.D., Ph.D. Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K220697

Device Name

Nitrile Patient Examination Gloves, Powder Free

Indications for Use (Describe)

Nitrile Patient Examination Gloves, Powder Free, are intended for medical purposes that are worn on the examiners' hands to prevent contamination between patient and examiner.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary K220697

APPLICANT

Company NameLalan Rubbers (Pvt) Ltd
AddressNo.95/B, Zone A, Export Processing Zone, Biyagama, MalwanaSri Lanka, EPZ 11672

CONTACT PERSON

NameRenuka Priyangi
DesignationManager - QA
Telephone0094716852746
Fax0094114311222
Emailqa@lalangroup.com

DATE PREPARED September 15, 2022

DEVICE

Trade NameNitrile Patient Examination Gloves, Powder Free
Common NameNitrile Patient Examination Gloves
ClassificationNitrile Patient Examination Gloves
Product CodeLZA
Device ClassClass I
C.F.R. Section21 CFR 880.6250
Classification PanelGeneral Hospital

LEGALLY MARKETED PREDICATE DEVICE

Product OwnerPrimus Gloves Private Limited
Trade namePrimus Nitrile Examination Gloves
510(k) NumberK143477
Device ClassClass I
Product codeLZA

DEVICE DESCRIPTION

The Nitrile Patient Examination Gloves, Powder Free are non-sterile, single use only, disposable, and powder free examination gloves. The glove is made of synthetic nitrile latex compound. The device is ambidextrous and can be worn on either the left or right hand. The device meets ASTM D 6319 - Standard specification for Nitrile Examination Gloves for Medical Application.

Characteristic

SterilityNon Sterile
MaterialNitrile
Surface treatmentInner chlorinated outer polymer coated

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ColorBlue
GeometryAmbidextrous
TextureFull textured
Cuff end finishingBeaded
UsageSingle use & Over-the counter
Target PopulationAdults
Available sizesEx Small, Small , Medium , Large, Ex Large
Shelf life3 Years

INDICATIONS FOR USE STATEMENT

Nitrile Patient Examination Gloves, Powder Free, are intended for medical purposes that are worn on the examiners' hands to prevent contamination between patient and examiner.

COMPARISON OF TECHNOLOGICAL CHARACTERISTICS

Predicate DeviceProposed SubjectDeviceComparisonResult
Trade namePrimus NitrileExamination GlovesNitrile PatientExamination Gloves,Powder FreeNotapplicable
510k NumberK143477K220697NotApplicable
Product OwnerPrimus Gloves PrivateLimitedLalan Rubbers (Pvt) LtdNotApplicable
Product CodeLZALZASame
RegulationNumber21 CFR 880.625021 CFR 880.6250Same
Regulatory Class11Same
Regulation NamePatient ExaminationGlovePatient ExaminationGloveSame
Classification PanelGeneral HospitalGeneral HospitalSame
Target PopulationAdultsAdultsSame
Intended Use/Indications for UseThe Nitrile PatientExamination gloves,Powder free, Blue color, is adisposable device intendedfor medical purposes that isworn on the examiners'hand or finger to preventcontamination betweenpatient and examiner.Nitrile PatientExamination Gloves,Powder Free, areintended for medicalpurposes that are wornon the examiners' handsto prevent contaminationbetween patient andexaminer.Same
MaterialCompositionSynthetic nitrile rubberSynthetic nitrile rubberSame
DesignNon-sterileNon-sterileSame
Single useSingle useSame
Powder-freePowder-freeSame

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AmbidextrousAmbidextrousSame
Beaded cuffBeaded cuffSame
SterilityNon-sterileNon-sterileSame
Shelf Life3 years3 yearsSame
Performancea. DimensionsMeets ASTM D6319requirementsMeets ASTM D6319requirementsSame
b. Physical PropertiesMeets ASTM D6319requirementsMeets ASTM D6319requirementsSame
c. Freedom from holesMeets ASTM D6319requirements of GI, AQL2.5Meets ASTM D6319requirements of GI, AQL2.5Same
d. Powder ResidualMeets ASTM D6319requirements; Not morethan 2.0mg/gloveMeets ASTM D6319requirements; Not morethan 2.0mg/gloveSame
e. SterilityNon-sterileNon-sterileSame
BiocompatibilitySkin IrritationUnder the conditions of thestudy not an irritantUnder the conditions ofthe study not an irritantSame
SkinSensitizationUnder the conditions of thestudy not a sensitizerUnder the conditions ofthe study not a sensitizerSame
In VitroCytotoxicityNo data availableUnder the conditions ofthe study for dilutedconcentrations 12.5% and6.25% are not cytotoxic.Undiluted extract (100%),diluted concentrations50% & 25% arecytotoxic.Similar
AcuteSystemicToxicityNo data availableUnder the conditions ofthe study no evidence ofsystemic toxicitySimilar

DISCUSSION OF NON-CLINICAL TESTS PERFORMED

Non-clinical tests were conducted to verify that the proposed subject device met all design specifications. The test results demonstrated that the proposed subject device complies with the following standards:

  • ASTM, D6319-19, Standard Specification for Nitrile Examination Gloves for Medical । Application
  • -ASTM, D6124-06 (Reapproved 2017), Standard Test Method for Residual Powder on Medical Gloves
  • ASTM, D5151-19, Standard Test Method for Detection of Holes in Medical Gloves -
  • ISO, 10993-10 Third Edition 2010-08-01, Biological evaluation of medical devices Part 10: -Tests for irritation and skin sensitization
  • ISO,10993-23 First edition 2021-01, Biological evaluation of medical devices Part 23: Tests for irritation
  • ISO,10993-11 Third edition 2017-09, Biological evaluation of medical devices Part 11: Tests for systemic toxicity

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  • ISO,10993-5 Third edition 2009-06-01, Biological evaluation of medical devices Part 5: -Tests for in vitro cytotoxicity
  • EN, 455-4:2009, Medical gloves for single use Part 4: Requirements and testing for shelf life determination
CharacteristicsStandard/SpecificationResult Summary
1. Physical Characteristics:
1.1 DimensionsASTM D6319Meets ASTM D6319 requirements forlength, palm width and thickness
LengthMinimum 230mmMinimum 240mm
Palm width (mm)
Size - XS$70 \pm 10$$\leq 80$
Size - S$80 \pm 10$$85\pm5$
Size - M$95 \pm 10$$95\pm5$
Size - L$110\pm 10$$105\pm5$
Size - XL$120 \pm 10$$\geq 110$
Thickness (mm) - single-wall
Fingerminimum 0.05Finger - $0.09 \pm 0.01$
Palmminimum 0.05Palm - $0.07 \pm 0.01$
Cuff-Cuff - $0.05 \pm 0.01$

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Image /page/7/Picture/0 description: The image shows the logo for Lalan Rubbers. The logo consists of a stylized symbol in blue and green, resembling a curved or flowing shape. To the right of the symbol is the word "LALAN" in bold, dark blue letters. Below "LALAN" is the word "Rubbers" in a smaller, lighter font.

1.2 PhysicalPropertiesASTM D6319Meets ASTM D6319 requirements fortensile strength and ultimateelongation before and afteraccelerated aging
Tensile Strength
Before Agingminimum 14 MPaminimum 14 MPa
After Agingminimum 14 MPaminimum 14 MPa
Ultimate Elongation
Before Agingminimum 500%minimum 500%
After Agingminimum 400%minimum 400%
2. Freedom fromholesASTM D6319ASTM D5151Meets ASTM D6319 and ASTM D5151requirements of AQL 2.5
3. Powder ResidualASTM D6319ASTM D6124Meets applicable requirement for powderfree; ≤ 2 mg per glove
4. Biocompatibility
Skin IrritationTestISO10993-23:2021Under the conditions of the study, not anirritant
Skin Sensitization Test(GPMT)ISO 10993-10:2010Under the conditions of the study, not asensitizer
In VitroCytotoxicityISO 10993-5:2009Under the conditions of the study, dilutedconcentrations 12.5% and 6.25% are notcytotoxic. Undiluted extract (100%),diluted concentrations 50% & 25% arecytotoxic.
Acute SystemicToxicityISO 10993-11: 2017Under the conditions of the study, noevidence of systemic toxicity

DISCUSSION OF CLINICAL TESTS PERFORMED

Clinical testing is not needed for this device.

CONCLUSION

The conclusions drawn from the non-clinical tests demonstrate that Nitrile Patient Examination Gloves, Powder Free is as safe as effective, and performs as well as or better than the legally marketed predicate device previously cleared under K143477.

§ 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.