K Number
K053366
Device Name
NITRILE EXAMINATION GLOVES, POWDERED, NON STERILE
Date Cleared
2006-03-30

(115 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Powdered Nitrile Examination Gloves, Non -Sterile is a disposable device and made of Synthetic Polymer that exhibits rubber like characteristics intended for medical purposes that is worn on the examiner's hands or finger to prevent contamination between patient and examiner.
Device Description
The Powdered Nitrile Examination Gloves, Blue, Non Sterile meets all the requirements of ASTM standard D 6319-00a53 and FDA 1000 ml Water Leak Test.
More Information

Not Found

No
The 510(k) summary describes standard examination gloves and makes no mention of AI or ML technology.

No.
The device, Powdered Nitrile Examination Gloves, is intended to prevent contamination between patient and examiner, not to provide therapy or treatment.

No
The description indicates the device is a glove used for contamination prevention during examinations, not for diagnosing medical conditions.

No

The device is a physical product (gloves) and does not involve any software component.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to be worn on the examiner's hands or finger to prevent contamination between patient and examiner. This is a barrier function, not a diagnostic test performed on a sample taken from the body.
  • Device Description: The description focuses on the physical properties and standards met by the gloves (ASTM standard, water leak test). It doesn't describe any components or processes related to analyzing biological samples.
  • Lack of IVD Indicators: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in a sample
    • Providing information for diagnosis, monitoring, or treatment decisions based on sample analysis.

This device is clearly described as a barrier device for infection control, which falls under a different regulatory category than IVDs.

N/A

Intended Use / Indications for Use

"Powdered Nitrile Examination Gloves, Non -Sterile is a disposable device and made of Synthetic Polymer that exhibits rubber like characteristics intended for medical purposes that is worn on the examiner's hands or finger to prevent contamination between patient and examiner."

Product codes (comma separated list FDA assigned to the subject device)

LZA

Device Description

"The Powdered Nitrile Examination Gloves, Blue, Non Sterile meets all the requirements of ASTM standard D 6319-00a53 and FDA 1000 ml Water Leak Test."

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hands or finger

Indicated Patient Age Range

Not Found

Intended User / Care Setting

examiner

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)

The performance test data of the non-clinical tests that support a determination of substantial equivalent is the same as mentioned immediately above. Clinical data is not needed for gloves or for most devices cleared by the 510 (k) processes.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K053344

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 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.

0

PT. MAHAKARYA INTI BUANA

Image /page/0/Picture/1 description: The image shows a stylized logo with the letters "MB" in a gothic or old English font. The letters are bold and black, with a textured appearance that gives them a three-dimensional effect. The overall design is simple yet striking, with the letters overlapping slightly to create a unified visual element.

K053366
Jalan Sei Belumai

Desa Dalu 10 A Dusun 1 N Tanjung Morawa - 20562 SUMUT - INDONESIA

MAR 3 0 2006

+62-61-7941880 l`el +62-61-7941882 l'ax

510 (K) SUMMARY

1.0 Submitter:

NamePT MAHAKARYA INTI BUANA
AddressJl. Sei Belumai, Desa Dalu 10 A Dusun I No. 18
Tanjung Morawa - 20362
SUMUT - INDONESIA
Phone No.+62-61-7944880
Fax No.+62-61-7944882

Date of Summary Prepared:

2.0 Contact Person:

Name:Mr. Sasitharan Nair
Phone:+62-61-7944880
Fax No.:+62-61-7944882

3.0 Name or the device:

| Trade Name | : | 1) Senstouch and
2) Multiple or Customers' Trade Name |
|---------------------|---|----------------------------------------------------------|
| Device Name | : | Powdered Nitrile Blue Examination Gloves, Blue. |
| Non | : | Sterile |
| Common Name | : | Examination Gloves |
| Classification Name | : | Nitrile Examination Gloves (Class I) |

4.0 Identification of The Legally Marketed Device:

Class I Nitrile Examination Gloves, 80LZA, powdered, that meets all the requirements of ASTM standard D 6319-00a53 and FDA 1000 ml Water Leak Test.

5.0 Description of The Device

The Powdered Nitrile Examination Gloves, Blue, Non Sterile meets all the requirements of ASTM standard D 6319-00a53 and FDA 1000 ml Water Leak Test.

6.0 Intended Use of The Device

The Powdered Nitrile Examination Gloves, Blue, Non Sterile is a disposable device intended for medical purposes that is worn on the examiner's to prevent contamination between patient and examiner.

1

1

PT. MAHAKARYA INTI BUANA

Image /page/1/Picture/1 description: The image shows a stylized logo with the letters "MB" in a bold, gothic-style font. The letters are large and take up most of the frame. The logo is black and white, with the letters appearing in solid black against a white background. The font style gives the logo a vintage or medieval appearance.

Jalan Sei Belumai Desa Dalu 10 A Dusun 1 No. 18 Tanjung Morawa -- 20362 SUMUT - INDONESIA

I el +62-61-7944880 +62-61-7944882 l·ax

7.0 Summary of The Technological Characteristics of The Device

The Powdered Nitrile Examination Gloves, Blue, Non Sterile are summarized with the following technological characteristics compared to ASTM or equivalent standards.

| CHARACTERISTICS | STANDARDS | DEVICE
PERFORMANCE |
|-----------------------|---------------------------------------|----------------------------------------|
| Dimension | D 6319-00aE3 | Meets |
| Physical Properties | D 6319-00aE3 | Meets |
| Freedom from Pinholes | D 6319-00aE3
FDA 21 CFR 800.20 | Meets |
| Powder Residue | D 6319-00aE3
D6124 - 01 | 10 mg/dm² |
| Biocompatibility | Primary Skin Irritation in
Rabbits | Passes
(No primary skin irritation) |
| | Dermal Sensitization | Passes
(No contact sensitizer) |

8.0 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 equivalent is the same as mentioned immediately above.

9.0 Substantial Equivalent Based on Assessment of Clinical Performance Data Clinical data is not needed for gloves or for most devices cleared by the 510 (k) processes.

10.0 Conclusion

It can be concluded that The Powdered Nitrile Blue Examination Gloves, Blue, Non Sterile will perform according to the gloves performance standards referenced in Section (7) above and meet ASTM standards, and FDA requirements for water leak test on pinhole AQL. Consequently, this device is substantially equivalent to currently marketed device.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image contains the text 'Public Health Service'. The text is in a bold, sans-serif font. The words are arranged on a single line.

DEPARTMENT OF HEALTH AND HUMAN SERVICES, USA

MAR 3 0 2006

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Sasitharan Nair Pt. Mahakarya Inti Buana J1 Sei Belumai, Desa Dalu 10 A Dusun I No. 18, Tanjung Morawa, Sumut Indonesia, 20362

Re: K053366

Trade/Device Name: Nitrile Examination Gloves, Powdered, Non Sterile Regulation Number: 880.6250 Regulation Name: Patient examination glove Regulatory Class: I Product Code: LZA Dated: March 3, 2006 Received: March 15, 2006

Dear Mr. Nair:

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 (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 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.

3

Page-2 Mr. Sasitharan Nair

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); 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 continue 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), please contact the Office of Compliance at (240) 276-0115. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act 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,

Chris

Chiu Lin, Ph.D. Director Division of Dental, Anesthesiology, General Hospital, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): 《OS-3366

Device Name:

Indications For Use:

NITRILE EXAMINATION GLOVES, POWDERED, NON STERILE

Powdered Nitrile Examination Gloves, Non -Sterile is a disposable device and made of Synthetic Polymer that exhibits rubber like characteristics intended for medical purposes that is worn on the examiner's hands or finger to prevent contamination between patient and examiner.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Jula P. Murphy 3/30/06

y, General H.
.31

K053344

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