K Number
K012819
Device Name
SEMPERMED DERMA PLUS, SIZES 5.5,6,6.5,7,7.5,8,8.5,9
Date Cleared
2001-11-16

(85 days)

Product Code
Regulation Number
878.4460
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination. (21CFR 878.4460)
Device Description
sempermed® DERMA plus is a powdered surgeon's glove and it is a disposable device made of natural rubber inside coated with synthetic latex material that bears powder to facilitate donning and it is intended to be worn on the hands usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. The glove is powdered with absorbable dusting powder USP Grade
More Information

Not Found

No
The 510(k) summary describes a standard surgical glove and contains no mention of AI or ML technology.

No.
The device description and intended use clearly state that the glove is for protection against contamination and infectious materials, which are preventive measures, not therapeutic actions to treat or cure a disease or condition.

No

The device description indicates that it is a surgeon's glove, intended to protect a surgical wound from contamination and act as a barrier against infectious materials. It does not mention any function related to diagnosing diseases or conditions.

No

The device description clearly states it is a physical surgeon's glove made of natural and synthetic rubber, which is a hardware component.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states the glove is "intended to be worn by operating room personnel to protect a surgical wound from contamination." This is a barrier function for protection during surgery.
  • Device Description: The description reinforces this by stating it's a "disposable device made of natural rubber... intended to be worn on the hands usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants."
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue, etc.) to provide information for diagnosis, monitoring, or treatment. IVDs are used in vitro (outside the body) to analyze these specimens.

Therefore, the sempermed® DERMA plus surgeon's glove is a medical device intended for barrier protection during surgical procedures, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination. (21CFR 878.4460)

Product codes

KGO

Device Description

sempermed® DERMA plus is a powdered surgeon's glove and it is a disposable device made of natural rubber inside coated with synthetic latex material that bears powder to facilitate donning and it is intended to be worn on the hands usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. The glove is powdered with absorbable dusting powder USP Grade

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hands

Indicated Patient Age Range

Not Found

Intended User / Care Setting

operating room personnel

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K981096

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4460 Non-powdered surgeon's glove.

(a)
Identification. A non-powdered surgeon's glove is a device intended to be worn on the hands of operating room personnel to protect a surgical wound from contamination. A non-powdered surgeon's 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).

0

Ka2819

510(k) Summary NOV 1 6 2001 As Required by 21 section 807.92 ( c )

1-Submitter Name:Semperit Technische Produkte GmbH & Co KG
2-Address:Modecentraße 22
A-1031 Vienna AUSTRIA
3-Phone:(++43) 2630 310 216
4-Fax:(++43) 2630 310 479
5-Contact Person:Dipl.-Ing. Richard Ehrenfeldner
6-Date summary prepared:August 18th, 2001
7- Official Correspondent:Mansour Consulting
8- Address:1308 Morningside Park Dr
Alpharetta, GA 30022 USA
9- Phone:(678) 908-8180
10- Fax:(425) 795-9341
11- Contact person:Jay Mansour, president
12-Device Trade or Proprietary Name:sempermed® Derma Plus
13-Device Common or usual name:Surgeon's glove
9-Device Classification Name:Surgeon's glove
10-Substantial Equivalency is claimed against the following device:"Supreme" Sempermed® Latex Surgeon's gloves, powder-free
510k #K981096 (refer to Appendix 2 for FDA notification letter
This notification for the sempermed® DERMA plus is of the
ABBREVIATED type as per the declaration of conformity on page 4

of this summary

11-Description of the Device:

sempermed® DERMA plus is a powdered surgeon's glove and it is a disposable device made of natural rubber inside coated with synthetic latex material that bears powder to facilitate donning and it is intended to be worn on the hands usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. The glove is powdered with absorbable dusting powder USP Grade

12-Intended use of the device: {Indications for use typed on a separate FDA form)

sempermed® DERMA plus is a powdered surgeon's glove and it is a disposable device made of natural rubber inside coated with synthetic latex material that bears powder to facilitate donning and it is intended to be worn on the hands usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. The glove is powdered with absorbable dusting powder USP Grade

13-Safety and effectiveness of the device:

The sempermed® DERMA plus is safe and effective as the predicate device "Supreme" Sempermed® Latex Surgeon's gloves, powder-free. Indeed, it is equivalent

This is better expressed in the tabulated comparison (Paragraph 14 below) PAGE 3.1

1

14-Summary comparing technological characteristics with other predicate device:

General comparison result between sempermed® DERMA plus gloves and the predicate device (sempermed® SUPREME) is tabulated below.

Technical comparison of specific elements is attached in the main submission

FDA file reference number510k 981096
Attachments inside notification
submission fileREFER TO APPENDIX 2
TECHNOLOGICAL
CHARACTERISTICSComparison result
REFER TO ADDITIONAL TECHNICAL
COMPARATIVE TABLE WITHIN 510K SUBMISSION
Indications for useIdentical
Target populationIdentical
DesignSimilar
MaterialsIdentical
PerformanceIdentical
SterilityIdentical
BiocompatibilityIdentical
Mechanical safetyIdentical
Chemical safetyIdentical
Anatomical sitesIdentical
Human factorsIdentical
Energy used and/or deliveredIdentical (not applicable)
Compatibility with
environment and other devicesIdentical
Where usedIdentical
Standards metIdentical
Electrical safetyIdentical (not applicable)
Thermal safetyIdentical (not applicable)
Radiation safetyIdentical (not applicable)

.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is an emblem featuring a stylized depiction of an eagle or bird-like figure with three curved lines representing its wings or feathers.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Semperit Technische Produkte Gesellshaft C/O Mr. Jay Mansour Official Correspondent Mansour Consulting 1308 Morningstar Park Drive Apharetta, Georgia 30022

Re: K012819

Trade/Device Name: Sempermed Derma Plus Powered Latex Surgeon's Gloves Regulation Number: 878.4460 Regulation Name: Surgeon's Glove Regulatory Class: I Product Code: KGO Dated: August 23, 2001 Received: August 23, 2001

NOV 1 6 2001

Dear Mr. Mansour:

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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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

3

Page 2 - Mr. Mansour

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

K.C. Lilient

Timothy A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

NOV 1 6 2001

Indication for Use Statement

Applicant: Semperit Technische Produkte Gesellshaft

510(k) Number (if known):_K012819

Device Name: Sempermed Dcrnia Plus Powdered Latex Surgeon's Gloves

Indications For Use:

A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination. (21CFR 878.4460)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Qien S. Lim

(Division Sign-Off) vision of Dental, Infection Control, Ceneral Hospital (ik) Number