K Number
K120693
Device Name
LATEX EXAMINATION GLOVES (POWDERED)
Date Cleared
2012-05-08

(62 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
A patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner.
Device Description
Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein) meets all the current specification for ASTM D3578-05 (2010).
More Information

Not Found

No
The device description and intended use clearly define a standard patient examination glove, with no mention of AI or ML capabilities. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

No
This device, a patient examination glove, is intended to prevent contamination between the patient and the examiner and does not directly treat or diagnose a medical condition.

No
Explanation: The device is a patient examination glove, intended to prevent contamination between patient and examiner. It does not perform any diagnostic function.

No

The device is a physical patient examination glove, which is a hardware medical device, not a software-only device.

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 device is a "disposable device intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner." This describes a barrier device used for protection, not a device used to examine specimens from the human body in vitro (outside the body) to provide diagnostic information.
  • Device Description: The description focuses on the physical properties and standards met by the glove (latex, powdered, protein content, ASTM standard). This aligns with a medical device used for physical protection.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, detecting analytes, providing diagnostic information, or any other activities typically associated with IVD devices.

Therefore, this device falls under the category of a general medical device, specifically a patient examination glove, and not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

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

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

LYY

Device Description

Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein) meets all the current specification for ASTM D3578-05 (2010).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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 device underwent non-clinical performance assessment based on the following characteristics and standards:

  • Dimensions: ASTM D 3578-05 (2010) - Meets
  • Physical Properties: ASTM D 3578-05 (2010) - Meets
  • Freedom from pin-holes: ASTM D 5151-99 (2006) and ASTM D 3578-05 (2010) - Meets
  • Powder Amount: ASTM D 6124-06 and ASTM D 3578-05 (2010) - Meets
  • Protein Content: ASTM D 5712-10 and ASTM D 3578-05 (2010) - Meets
  • Biocompatibility:
    • Dermal Sensitization (as ISO 10993-10:2010) - Not a contact skin sensitizer
    • Primary Skin Irritation Test (as ISO 10993-10:2010) - Not a primary skin irritant

Clinical data was not needed for market cleared examination gloves.

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.

K003737

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

K120093

TOP CALIBRE SDN. BHD.

  • WAY. -- 8 2012

FDA 510(k), Premarket Notification: 510(k) Summary of Safety and Effectiveness Information

Date: 11 April 2012

1.0 Submitter:

Top Calibre Sdn Bhd 1-1, 2, Jalan Setia Prima U13/S Setia Alam, Seksyen U13, 40170 Shah Alam, Selangor, Malaysia

Telephone No .: 4603 3291 0516 +603 3291 0542 Fax No.:

2.0 Contact Person:

Contact:Ms Tracy Ngui
Telephone No.:+603 3291 0516
Fax No.:+603 3291 0542

Name of Device: 3.0

Trade Name: Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm- of glove or Less of Water Extractable Protein) Patient Examination Glove Common Name:

Classification Name: Patient Examination Glove

4.0 Identification of the Legally Marketed Device:

Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein), Class I patient examination gloves, Latex - 80LYY, meets all of the requirements of ASTM D3578-05 (2010) Standard Specification for Rubber Examination Glove.

Predicate Device: K003737, Powdered Latex Patient Examination Glove, With Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein)

1

TOP CALIBRE SDN. BHD.

Description of Device: 5.0

Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein) meets all the current specification for ASTM D3578-05 (2010).

6.0 Intended Use of the Device:

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

Summary of the Technological Characteristics of the Device: 7.0

Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm² of glove or Less of Water Extractable Protein) possesses the following technological characteristic (as compared to ASTM or equivalent standards):

CharacteristicStandardsDevice Performance
DimensionsASTM D 3578-05
(2010)Meets
Physical PropertiesASTM D 3578-05
(2010)Meets
Freedom from pin-holesASTM D 5151-99
(2006)Meets
ASTM D 3578-05
(2010)
Powder AmountASTM D 6124-06Meets
ASTM D 3578-05
(2010)
Protein ContentASTM D 5712-10Meets
ASTM D 3578-05
(2010)
BiocompatibilityDermal Sensitization
(as ISO 10993-
10:2010)Not a contact skin sensitizer
Primary Skin
Irritation Test
(as ISO 10993-
10:2010)Not a primary skin irritant

2

TOP CALIBRE SDN. BHD.

Substantial Equivalent Based on Assessment of Non-Clinical Performance 8.0 Data

The performance test data that support a determination of substantial equivalence are described above.

Substantial Equivalent Based on Assessment of Clinical Performance Data 9.0

. Clinical data is not needed for market cleared examination gloves.

10.0 Conclusion

It can be concluded that the Powdered Latex Patient Examination Glove with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein), is safe and effective for use with chemotherapeutic agents and will perform according to the glove performance standards referenced in Section 7.0 above, thereby meeting ASTM standards, FDA requirements, and the labeling claims for the product.

The device comparison below outlines the similarity, and/or differences between the proposed device and the predicate device for the substantial equivalent determination.


CharacteristicsPredicate DeviceProposed Device
K003737, Powdered Latex
Patient Examination Glove with
Protein Content Labeling Claim
(200 Micrograms per gram of
glove less)Powdered Latex Patient
Examination Glove, with Protein
Content Labeling Claim
(Contains 200 Micrograms per
dm² of glove or less of Water
Extractable Protein)
Device Description/
Regulation NumberPatient Examination Glove/
21 CFR Part 880.6250Identical
Product Code80 LYYIdentical
Intended UseIntended for medical purposes
that is worn on the examiner's
hand to prevent contamination
between patient and examiner.Identical
Indications for UseA patient examination glove is a
disposable device intended for
medical purposes that is worn
on the examiner's hand to
prevent contamination between
patient and examiner.Identical
CharacteristicsPredicate DeviceProposed Device
Powdered
Latex
K003737,Powdered Latex Patient
Patient Examination Glove withExamination Glove, with Protein
Protein Content Labeling ClaimContent Labeling Claim
(200 Micrograms per gram of(Contains 200 Micrograms per
glove less)dm2 of glove or less of Water
Extractable Protein)
DesignAmbidextrous, in different sizes
per ASTM D3578 dimension
requirementIdentical
MaterialsNatural Rubber LatexIdentical
ColorNatural ColorIdentical
PerformanceNot Applicable (Non-Sterile)Identical
Sterility
I.
Freedom from
II.Meets ASTM D3578Identical
holes
Dimension
III.Meets ASTM D3578Identical
Physical
IV.
PropertiesMeets ASTM D3578Identical
V.
Powder
AmountMeets ASTM D3578Identical
VI-
-ProteinMeets-ASTM-D3578Identical-
Content
Single UseYesIdentical
BiocompatibilityPasses
Testi. Primary Skin Irritation TestIdentical
ii. Dermal Sensitization TestIdentical
PackagingPacked in Dispenser BoxesIdentical
Labeling ClaimExtractable
Protein
With
Content Labeling ClaimIdentical

Substantial Equivalence Comparison Table

Page 3 of 4 (Revision 1)

3

TOP CALIBRE SDN. BHD.

and the comments of the comments of the comments of

:

. . .

and the control of the county of

4

Image /page/4/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular, with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. In the center of the seal is a stylized image of a caduceus, a symbol of medicine and healing, featuring a staff with two snakes coiled around it. The caduceus is oriented diagonally, pointing upwards and to the right.

Public Health Service

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

Ms. Tracy Ngui Quality Assurance Manager Top Calibre Sdn. Bhd 1-1, 2, Jalan Setia Prima U13/S Setia Alam, Seksyen U13, 40170 Shah Alam, Selangor, MALAYSIA

MAY - 8 2012

Re: K120693

Trade/Device Name: Powdered Latex Patient Examination Gloves with Protein Content Labeling Claim (Contains 200 Micrograms per dm2 of Glove or Less of Water Extractable Protein) Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LYY Dated: April 11, 2012 Received: April 12, 2012

Dear Ms. Tracy Ngui:

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.

5

Page 2 - Ms. Ngui

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 device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices ucm 1 15809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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.html 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 Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours.

Anthony - D. Owens

Anthony D. Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Indications for Use

510(k) Number (if known):

Powdered Latex Patient Examination Gloves with Protein Content labeling Claim Device Name: (Contains 200 Micrograms per dm2 of glove or Less of Water Extractable Protein)

Indications for Use:

A patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand 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) X

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

Concurrence of CDRH, Office Of Device Evaluation (ODE)

Elizabetk. F-Clunie-Willen

(Division Sign-Off) (Division Sign-On)
Division of Anesthesiology, General Hospital Infection Control, Dental Devices

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510(k) Number: K120693