K Number
K122788
Device Name
TEXTURED, NATURAL TO OFF-WHITE, LATEX, STERILE, POWDER FREE EXAMINATION GLOVES, WITH PROTEIN LABELING CLAIM (50 UG/DM2 O
Date Cleared
2013-01-17

(128 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The examination glove is a disposuble device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.
Device Description
Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50µg/dm² or Less of Water Soluble Protein)
More Information

Not Found

No
The device is a standard examination glove and the description and performance studies focus on material properties and safety, with no mention of AI or ML.

No
The device, an examination glove, is intended for preventing contamination between a patient and examiner, which is a protective rather than a therapeutic function.

No
The device, an examination glove, is intended for preventing contamination, not for diagnosing any medical condition or disease. Its function is to provide a barrier.

No

The device description clearly states it is a physical examination glove made of latex, 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 is to prevent contamination between patient and examiner by being worn on the hand or finger. This is a physical barrier function, not a diagnostic test performed on samples taken from the body.
  • Device Description: The description details the physical characteristics of a glove. There is no mention of reagents, assays, or any components used for 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 specific substances (analytes)
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions.

The device is clearly described as an examination glove, which falls under the category of medical devices used for protection and barrier purposes.

N/A

Intended Use / Indications for Use

The Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50ug/dm² or Less of Water Soluble Protein) is a Disposable device intended for medical purposes to be worn on the examiner's hand or finger to prevent contamination between patient and examiner.
The sterile latex 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.

Product codes

LYY

Device Description

Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50ug/dm² or Less of Water Soluble Protein)
Sterile, powder free, examination gloves made of latex. The gloves are provided in sizes small, medium, and large.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hand 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 Latex Sterile Powder Free Examination Gloves meet the requirements of established standards ASTM D3578-05, ASTM D5712-10, ASTM D5151-06, ASTM D6124-06 and ISO 10993-10.
Nonclinical data assessment:

  • Dimension: Meets ASTM Standard D3578
  • Physical Properties: Meets ASTM Standard D3578
  • Freedom from Pinholes: Meets 21 CFR 800.20; ASTM D5151
  • Powder Residual: Meets ASTM Standard D6124, values below 2mg of residual powder
  • Protein Level: Meets ASTM Standard D5712, values below 50 mcg/gm
  • Biocompatibility: Passes Primary Skin Irritation in Rabbits (ISO 10993-10), Passes Guinea Pig Maximization (ISO 10993-10). Gloves do not display any potential for sensitization.

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

Not Found

Predicate Device(s)

K090327

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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

Abbreviated 510(k) Premarket Notification Latex Sterile Powder Free Examination Gloves Section 5, 510(k) Summary Page 1 of 3

5.510(k) SUMMARYK122788
DATE:February 17, 2012
OWNER:Northstar Healthcare Holdings
70 Sir John Rogerson's Quay
Dublin 2, IrelandJAN 17 2013
OFFICIAL CORRESPONDENT:Michael Riordan
Operations Manager
Telephone: 00353-21-4548255
Fax: 00353-21-4548294
Email: michael.riordan@mckesson.ie
DEVICE NAME:Trade Name:Textured, White, Latex, Sterile Powder Free
Examination Gloves with Protein labeling Claim
(50µg/dm² or Less of Water Soluble Protein)
Common Name:Patient Examination Gloves
Classification:Patient Examination Gloves
Class:Class I
Product Code:LYY

PREDICATE DEVICE(S):

| Predicate
510(k) | Device Name | Indication | Clearance
Date | Company |
|---------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------|-----------------------|
| K090327 | Powder Free Polymer
Coated Latex
Examination Gloves,
Sterile, with Protein
labeling Claim
(50 $ μ $ g/dm² or Less of
Water Soluble Protein) | A powder free polymer coated latex
examination glove is a disposable device
made of natural rubber material intended to
be worn on the hand for medical purposes to
provide barrier against potentially infectious
materials and other contaminants. | 03 Apr 2009 | Wear Safe SDN,
BHD |

DEVICE DESCRIPTION: Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50μg/dm² or Less of Water Soluble Protein)

1

STATEMENT OF INTENDED USE:

The Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50ug/dm² or Less of Water Soluble Protein) is a Disposable device intended for medical purposes to be worn on the examiner's hand or finger to prevent contamination between patient and examiner.

TECHNOLOGICAL CHARACTERISTICS:

The Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50µg/dm² or Less of Water Soluble Protein) is substantially equivalent to the predicate device with regard to physical characteristics, design, product features, and intended use. Both gloves are made with latex using similar manufacturing processes.

FeaturePowder Free Polymer Coated Latex Examination Gloves, Sterile, with Protein labeling Claim (50µg/dm² or Less of Water Soluble Protein) K090327 PredicateTextured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50µg/dm² or Less of Water Soluble Protein) (Proposed)
Intended UseIntended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner.Same
Indications for Use StatementA powder free polymer coated latex examination glove is a disposable device made of natural rubber material intended to be worn on the hand for medical purposes to provide barrier against potentially infectious materials and other contaminants.The sterile latex 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.
DescriptionSterile, powder free, examination gloves made of latex. The gloves are provided in sizes small, medium, and large.Same
PresentationSterile gloves are provided in dispenser boxes.Same
ColorWhiteWhite
MaterialLatexSame
SterilizationSterileSame
Single UseYesSame
DimensionsMeets ASTM D3578-05Length Small 220mm min.
Medium, Large 230 mm min.
Width Small 80-90mm
Medium 90-100mm
Large 101-111mm
Thickness Finger 0.13 mm min.
Palm 0.11 mm min.
Physical PropertiesMeets ASTM D3578-05Before aging/after aging
Elongation 650% 500%
Tensile Strength 18MPa 14MPa
Freedom from PinholesMeets ASTM D5151-06Same
Residual PowderMeets ASTM D6124-06Same
Protein LevelMeets ASTM D5712-10Same

2

| Biocompatibility
Tests | Passes Primary Skin Irritation in Rabbits
Passes Guinea Pig Maximization | Same
Same |
|---------------------------|-----------------------------------------------------------------------------|--------------|
| Sterilization | Radiation dose of 25 kGy. | Same |

ASSESSMENT OF NONCLINICAL DATA:

| Characteristic | Standard | Device
Performance |
|-------------------------------------------------------------|------------------------------|-------------------------------------------------------------------------|
| Dimension | ASTM Standard D3578 | Meets |
| Physical Properties | ASTM Standard D3578 | Meets |
| Freedom from Pinholes | 21 CFR 800.20; ASTM
D5151 | Meets |
| Powder Residual | ASTM Standard D6124 | Meets
Results generated
values below 2mg
of residual
powder |
| Protein Level | ASTM Standard D5712 | Meets
Results generated
values below 50
mcg/gm |
| | Biocompatibility | Primary Skin Irritation
in rabbits
(ISO 10993-10) |
| Dermal Sensitization in
the guinea pig (ISO
10993-10) | | Gloves do not
display any
potential for
sensitization |

CONCLUSIONS:

The Latex Sterile Powder Free Examination Gloves meet the requirements of established standards ASTM D3578-05, ASTM D5712-10, ASTM D5151-06, ASTM D6124-06 and ISO 10993-10.

Based on the comparison of intended use, design, materials and performance, the Latex Sterile Powder Free Examination Gloves are substantially equivalent to the predicate device.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

Image /page/3/Picture/12 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized abstract symbol to the right and text arranged in a circular fashion to the left. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

January 17, 2013

Northstar Healthcare Holdings C/O Mr. Ned Devine Responsible Third Party Official Underwriters Laboratories, Incorporated 333 Pfingsten Road Northbrook, IL 60062

Re: K122788

Trade/Device Name: Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein Labeling Claim (50ug/dm2 or Less of Water Soluble Protein) Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LYY Dated: November 27, 2012 Received: January 4, 2013

Dear Mr. Devine:

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.

4

Page 2 - Mr. Devine

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/ucm115809.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.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 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/ResourcesforYou/Industry/default.htm.

Sincerely yours.

Clinton D. Annett

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

Enclosure

5

INDICATIONS FOR USE

510(k) Number (if known): K122788

Device Name:

Textured, White, Latex, Sterile Powder Free Examination Gloves with Protein labeling Claim (50µg/dm² or Less of Water Soluble Protein)

Indications for Usc: The examination glove is a disposuble device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

AND/OR

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

ੱਤੀ ﺗﺸﻬﺪ

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF needed)

Concur valuation (ODE) (Division Sign-Off) Division of Anesthesiology, General Hospital Infection Control, Dental Devices 188 510(k) Number:

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