K Number
K132221
Device Name
POWDER-FREE VINYL PATIENT EXAMINATION GLOVES
Date Cleared
2014-01-31

(198 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 upon the examiner`s hands or finger to prevent contamination between patient and examiner.
Device Description
A Powder-Free Vinyl Patient Examination Gloves is a disposable device intended for medical purposes that is worn upon the examiner's hands or finger to prevent contamination between patient and examiner.
More Information

Not Found

No
The device is a patient examination glove, and the description and performance studies focus on material properties and barrier function, with no mention of AI/ML.

No.
The device is a patient examination glove, which is used to prevent contamination and is not designed to treat or cure a medical condition.

No

Explanation: The device is a patient examination glove, described as a disposable device for preventing contamination between patient and examiner. Its intended use does not involve diagnosing medical conditions, but rather providing a barrier for protection.

No

The device is a physical glove, not software. The description clearly states it is a disposable device worn on the hands or fingers.

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 hands or finger. This is a physical barrier function, not a diagnostic test performed on samples from the human body.
  • Device Description: The description reinforces the physical barrier function of the glove.
  • Lack of IVD Characteristics: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting specific substances, or providing diagnostic information about a patient's condition.
  • Performance Studies: The performance studies focus on physical properties (dimensions, water fill test) and biological reactions (skin irritation, sensitization), which are relevant to a medical device worn on the body, not an IVD.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or screening purposes. This glove does not fit that description.

N/A

Intended Use / Indications for Use

A patient examination glove is a disposable device intended for medical purposes that is worn upon the examiner`s hands or finger to prevent contamination between patient and examiner.

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

LYZ

Device Description

A Powder-Free Vinyl Patient Examination Gloves is a disposable device intended for medical purposes that is worn upon the examiner's hands or finger to prevent contamination between patient and examiner.

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 / 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 standards used for Shandony Haoyu Medical Products, Co. Ltd. Lloves product are based on ASTM-D-6319 and ASTM D-5250. All testing meets requirements for physical and dimensions testing conducted on gloves. Inspection level S-2, AQL 2.5.

The FDA 1000 ml Water Fill Test based on ASTM-D5151-06 was also conducted samplings of AQL 2.5 inspection level G-1. meeting these requirements. Primary Skin Irritation and Skin Sensitization (allergic contact dermatitis) testing was conducted with results showing no primarv skin irritant or sensitization reactions.

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.

K100699, K022091

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.

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KI32221

JAN 3 1 2014

510(K) SUMMARY

Page 1 of 3

This summary of 510(K) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and 21 CFR 5807.92.

    1. Submitter's Identification:
      Shandong Haoyu Medical Products Co., Ltd. No.8. Nanhuan Road. Shaozhuang Industry Park Qingzhou, Shandong, China

Contact Person: Shao Le Phone Number: 011-86-536-3840824

Date summary prepared: Jan 22, 2014

2. Name of the Device:

Powder Free Vinyl Patient Examination Gloves

3. Predicate Device Information:

Shijiazhuang Star Plastics Co., Ltd. Powder Free Vinyl Patient Examination Gloves. Clear (K100699)

Tangshan Zhonghong Pulin Food Products Co., Ltd. Class I vinyl patient examination gloves, powder-free (K022091)

4. Device Description:

A Powder-Free Vinyl Patient Examination Gloves is a disposable device intended for medical purposes that is worn upon the examiner's hands or finger to prevent contamination between patient and examiner.

5. Standard Description:

Our Powder-Free Vinyl Patient Examination Gloves do not contain any UPS powder according to the results of testing conducted on the gloves. The residual powder testing is conducted per standards of ASTM D-6124-06. which demonstrates that the powder free glove is less than 2mg/pc. Classified by FDA 's General and Plastic Surgery Device panel as Class 1. 21 CFR 880.6250, Powder-Free Vinyl Patient Examination Glove. 80LYZ. and meets all requirement of ASTM Standard D5250-06.

6. Intended Use:

A patient examination glove is a disposable device intended for medical purposes that is worn upon the examiner`s hands or finger to prevent contamination between patient and examiner.

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    1. Comparison to Predicate Devices on Indication for Use: Our Powder Free Vinyl Patient Examination Gloves are substantially equivalent in safety and effectiveness to Tangshan Zhonghong Pulin Food Products Co., Ltd. (K022091) and Shijiazhuang Star Plastics Co., Ltd. (K100699) Powder-Free Vinyl Patient Examination Gloves.

Discussion of Non-Clinical Test Performed for Determination of Substantial 8. Equivalence are as Follows:

The standards used for Shandony Haoyu Medical Products, Co. Ltd. Lloves product are based on ASTM-D-6319 and ASTM D-5250. All testing meets requirements for physical and dimensions testing conducted on gloves. Inspection level S-2, AQL 2.5.

The FDA 1000 ml Water Fill Test based on ASTM-D5151-06 was also conducted samplings of AQL 2.5 inspection level G-1. meeting these requirements. Primary Skin Irritation and Skin Sensitization (allergic contact dermatitis) testing was conducted with results showing no primarv skin irritant or sensitization reactions.

There are no special labeling claims and we do not claim our gloves as hypoallergenic is conducted to insure that our gloves meet our "powder-free" claims (contain no more than 2 mg powder per glove).

9. Sterilization

There is no specific device for non-sterile examination gloves. Hand hygiene by rubbing with an alcohol-based hand rub or by washing with soup and water should be performed when appropriate.

10. Discussion of Clinical Tests Performed:

Not Applicable - There is no hypoallergenic Claim.

l l. Conclusions:

Our Powder-Free Vinyl Patient Examination Gloves conforms fully to ASTM-D-5250-06 standard as well as applicable 21 CFR references. and. meets pinhole FDA requirements, biocompatibility requirements and labeling claims. and are substantially equivalent in all technological characteristics. including tensile strength. ultimate elongations size. thickness. residual powder and pinhole to predicate devices. There are no safety/efficacy issues or new claims from the "substantial equivalence" products cited.

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Page 3 of 3

| | Proposed Device | Predicate Device
(K022091) | Predicate Device (K100699) |
|-------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------|
| Description | Powder Free Vinyl
Patient Examination
Gloves | Class I vinyl patient
examination gloves,
powder-free
(Tangshan Zhonghong
Pulin Food Products
Co., Ltd ) | Powder Free Vinyl Patient
Examination Gloves, Clear
(Shijiazhuang Star Plastic
Co., Ltd) |
| Indication for Use | Disposable device
intended for medical
purposes that is worn
on the examiner's hand
or finger to prevent
contamination between
patient and examiner | Substantially equivalent | Substantially equivalent |
| Basic Design | A garment covering the
hand and wrist area.
Have separate openings
for each finger and the
thumb. | Substantially equivalent | Substantially equivalent |
| Materials Used | Poly Vinyl Chloride | Same | Same |
| Single Use | Yes | Yes | Yes |
| Size | S.M.L,XL | S,M,L,XL | Information Unavailable |
| Sterile | Not sterile | Not sterile | Not sterile |
| Dimension | Meets ASTM D5150-
06 | Meets ASTM D5150-06 | Meets ASTM D5150-06 |
| Physical Property | Meets ASTM D5150-
06 | Meets ASTM D5150-06 | Meets ASTM D5150-06 |
| Free of Pinhole | Meets ASTM D5151-
06 | Meets ASTM D5151-06 | Meets 21 CFR 800.20 |
| Residue Powder | Meets ASTM D6124-
06 | Meets ASTM D6124-06 | Meets ASTM D6124-06 |
| Primary Skin Irritation | Not an irritant | Not an irritant | Not an irritant |
| Dermal Sensitization | Not a sensitizer | Not a sensitizer | Not a sensitizer |
| Summary of comparison | Our Powder-Free Vinyl Patient Examination Gloves (subject device) and
Tangshan Zhonghong Pulin Food Products Co., Ltd Class I vinyl patient
examination gloves, powder-free (K022091) (predicate device), and Shijiazhuang
Star Plastic Co Ltd Powder Free Vinyl Patient Examination Gloves. Clear
(K100699) (predicate device) are substantially equivalent in all technological
characteristics, including tensile strength, ultimate elongations size, thickness,
residual powder and pinhole. | | |

Side-by-Side Comparison of Intended Use, Design, Material, Physical, Biocompatibility, and Performance Testing

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

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

January 31, 2014

Shandong Haoyu Company Medical Products Company, Limited C/O Mr. Ray Zhou Official Correspondent Basic Medical Industries, Incorporated 12390 East End Avenue Chino, CA 91710

Re: K132221

Trade/Device Name: Powder-Free Vinyl Patient Examination Gloves . Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LYZ Dated: December 30, 2013 Received: January 2, 2014

Dear Mr. Zhou:

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

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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.

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Erin I. Keith, M.S. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K132221

Device Name

Powder Free Vinyl Patient Examination Gloves

Indications for Use (Describe)

A patient examination glove is a disposable device intended for medical purposes that is worn upon the examiner's hands or fingers 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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FORM FDA 3881 (1/14)

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page

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