K Number
K160781
Device Name
Sempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons Gloves
Date Cleared
2017-05-02

(406 days)

Product Code
Regulation Number
878.4460
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Sterile Powder Free Synthetic Rubber Gloves is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.
Device Description
Sempermed Syntegra IR is a sterile powder-free surgeon glove. It is a disposable device made of synthetic polyisoprene rubber inside coated with synthetic material to ease donning the glove. This glove is intended to be worn on hands, usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants.
More Information

Not Found

No
The device is a surgical glove and the summary describes standard performance testing for gloves, with no mention of AI/ML or related concepts.

No
The device is a surgical glove, which acts as a barrier to protect against contamination and infectious materials. It does not actively treat or diagnose a disease or condition, which is the primary function of a therapeutic device.

No
The device is a surgical glove, described as a barrier to protect against contamination and infectious materials, not for diagnosing medical conditions.

No

The device is a physical glove made of synthetic rubber, not software. The description clearly details its material and physical properties.

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

Here's why:

  • Intended Use: The intended use is to protect a surgical wound from contamination and provide a barrier against potentially infectious materials. This is a physical barrier function, not a diagnostic test performed in vitro (outside the body) on specimens like blood, urine, or tissue.
  • Device Description: The description focuses on the material, sterility, and function as a barrier worn on the hands. It does not mention 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:
    • Analysis of biological specimens.
    • Detection or measurement of analytes.
    • Diagnostic purposes (e.g., identifying a disease, monitoring a condition).
    • Reagents or test kits.

The device is clearly described as a surgical glove, which falls under the category of medical devices used for protection and barrier purposes, not for in vitro diagnosis.

N/A

Intended Use / Indications for Use

The Sterile Powder Free Synthetic Rubber Gloves is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

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

KGO

Device Description

Sempermed Syntegra IR is a sterile powder-free surgeon glove. It is a disposable device made of synthetic polyisoprene rubber inside coated with synthetic material to ease donning the glove. This glove is intended to be worn on hands, usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants.

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 / surgical settings

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 performance meets the following standards:

  • Dimensions: ASTM 3577-09, Meets standard requirements
  • Physical Properties: ASTM 3577-09, Meets standard requirements
  • Thickness: ASTM 3577-09, Meets standard requirements
  • Biocompatibility (Irritation): ISO 10993-10:2002/Amd 1:2006(E), Pass, Under the conditions of the studies, the device is non-irritating
  • Biocompatibility (Hypersensitivity): ISO 10993-10:2002/Amd 1:2006(E), Pass, Under the conditions of the studies, the device is a non-sensitizer.
  • Watertight (1000ml): ASTM D 5151, Pass

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.

K013560

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

§ 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).

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized symbol featuring three human profiles facing to the right, with flowing lines above them, possibly representing hair or movement.

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

May 2, 2017

Semperit Investments Asia Pte. Ltd. % Thomas Knott Senior Regulatory Advisor Benjamin L. England & Associates, LLC 810 Landmark Dr. Suite 126 Glen Burnie, Maryland 21061

Re: K160781

Trade/Device Name: Sempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons Gloves Regulation Number: 21 CFR 878.4460 Regulation Name: Surgeon's Glove Regulatory Class: I Product Code: KGO Dated: March 27, 2017 Received: March 29, 2017

Dear Thomas Knott:

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.

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

1

Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated 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 Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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.

Michael J. Ryan -S

for Tina Kiang, Ph.D. Acting Director Division of Anesthesiology. General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K160781

Device Name

Sempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons Gloves

Indications for Use (Describe)

The Sterile Powder Free Synthetic Rubber Gloves is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

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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Image /page/3/Picture/0 description: The image shows the logo for Semperit, a company that specializes in rubber and plastic products. The logo consists of the word "SEMPERIT" in large, bold, blue letters, followed by a blue circle with a stylized "S" inside. The logo is simple and modern, and the blue color gives it a professional and trustworthy look. The logo is likely used on the company's website, marketing materials, and products.

510(k) Summary

1.0 Submitter :

Semperit Investment Asia Pte. Ltd. (SIA) 8 Jurong Town Hall Road, #29-03 to 06 The JTC Summit Singapore 609434

Phone No.:+65 6705 2257
Fax No.:+65 6274 6977
Contact Person:Clemens Eichler

Date of Preparation April 20, 2017

2.0 Name of the Device

Trade NameSempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons Gloves
Common NameSynthetic Rubber Surgical Gloves
Classification NameSterile Surgical Gloves
510(K) NumberK160781

3.0 Identification of The Legally Marketed Devices That equivalency is claimed:

Primary Predicate:K013560
-----------------------------
Name of the Device:Sempermed® Supreme
Company:SEMPERIT TECHNISCHE PRODUKTE
GESELLSCHAFT M.B.H.

4.0 Description of the Device:

Sempermed Syntegra IR is a sterile powder-free surgeon glove. It is a disposable device made of synthetic polyisoprene rubber inside coated with synthetic material to ease donning the glove. This glove is intended to be worn on hands, usually in surgical

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Image /page/4/Picture/0 description: The image shows the word "SEMPERIT" in large, bold, blue letters. To the right of the word is a blue circle with a stylized "S" shape inside. The text and symbol appear to be a logo for a company or organization.

settings, to provide a barrier against potentially infectious materials and other contaminants.

5.0 Indications for Use

The Sterile Powder Free Synthetic Rubber Surgical Gloves is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

6.0 Summary of the Technological Characteristics of the Device:

The Sterile Powder Free Synthetic Rubber Surgical Gloves is summarized with the following technological characteristics compared to ASTM Specification D3577-09 Standard Specification for Rubber Surgical Gloves or equivalent standards.

| CHARACTERISTICS | STANDARDS | DEVICE
PERFORMANCE |
|---------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------|
| Dimensions | ASTM 3577-09 | Meets standard
requirements |
| Physical Properties | ASTM 3577-09 | Meets standard
requirements |
| Thickness | ASTM 3577-09 | Meets standard
requirements |
| Biocompatibility | ISO 10993-10:2002/Amd
1:2006(E) Biological
evaluation of medical devices
– Part 10: Tests for irritation
and delayed-type
hypersensitivity – Amendment
1:2006-07-15 | Pass
Under the conditions of the
studies, the device is non-
irritating |
| | ISO 10993-10:2002/Amd
1:2006(E) Biological
evaluation of medical devices
– Part 10: Tests for irritation
and delayed-type
hypersensitivity – Amendment
1:2006-07-15 | Pass
Under the conditions of the
studies, the device is a non-
sensitizer. |

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Image /page/5/Picture/0 description: The image shows the word "SEMPERIT" in large, bold, blue letters, followed by a blue circular logo. The logo appears to be a stylized letter "S" enclosed within a circle. The text and logo are aligned horizontally and are the primary focus of the image.

Watertight (1000ml)ASTM D 5151Pass
----------------------------------------

Substantial Equivalent Based on Assessment of Non-Clinical Performance Data 7.0

The performance test data of non-clinical tests that support a determination of substantial equivalence is the same as mentioned immediately above.

8.0 Substantial Equivalence Comparison

| CHARACTER-

ISTICSSTANDARDSDEVICE PERFORMANCECONCLUSION
PredicateCurrent
ApplicantSemperit Technische
Produkte GmbH & Co
KGSemperit
Investment
Asia Pte, Ltd. (SIA)
510(k) NumberK013560K160781
DimensionsASTM D3577Meets,Meets,Identical
$\leq$ 0.10 mmMin 0.10 mmMin 0.10 mm
Physical
Properties
Before AgingASTM D3577Meets,Meets,Identical
Tensile Strength:$\geq$ 17 MPa24 MPa min17 MPa min
Ultimate
Elongation:650 % min750% min650% min
Stress at 500%
Elongation:$\leq$ 7.0 MPa7.0 MPa7.0 MPa
Physical
Properties After
AgingASTM D3577Meets,Meets,Identical
Tensile Strength:$\geq$ 12 MPa18 MPa min12 MPa min
Ultimate
Elongation490 % min560 % min490 % min
Powder FreeASTM D6124-06Meets,Meets,Identical
Requirements of $\leq$ 2Requirements of $\leq$ 2
CHARACTER-
ISTICSSTANDARDSDEVICE PERFORMANCECONCLUSION
(≤ 2 mg/glove)mg/glove for Powder-
Free designation per
ASTM D3577mg/glove for Powder-
Free designation per
ASTM D3577
Sterile or Non-
sterile-SterileSterileIdentical
BiocompatibilityPrimary Skin
Irritation
ISO 10993-10Under the conditions of
the studies, the device
is non-irritatingUnder the conditions of
the studies, the device is
non-irritatingIdentical
Dermal
Sensitization -
ISO 10993-10Under the conditions of
the studies, the device
is a non-sensitizerUnder the conditions of
the studies, the device is
a non-sensitizerIdentical
Watertight
(1000ml)ASTM D5151Passes
ASTM D3577 when
tested in accordance
with ASTM 5151
Inspection Level 1,
AQL 1.5Passes
ASTM D3577 when
tested in accordance
with ASTM 5151
Inspection Level 1,
AQL 1.5Identical
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.The Sterile Powder Free
Synthetic Rubber
Gloves is a single use
disposable device
intended to be worn by
operating room
personnel to protect a
surgical wound from
contamination.Identical
MaterialASTM D6319-10Natural LatexSynthetic RubberSimilar
Innercoating-SyntheticSyntheticIdentical
Color-Natural WhiteCrèmeSimilar
CHARACTER-
ISTICSSTANDARDSDEVICE PERFORMANCEDEVICE PERFORMANCECONCLUSION
Texture-Textured (Micro-rough)Textured (Micro-rough)Identical
Size-51/2, 6, 61/2, 7, 71/2, 8, 81/2, and 951/2, 6, 61/2, 7, 71/2, 8, 81/2, and 9Identical

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Image /page/6/Picture/0 description: The image shows the word "SEMPERIT" in blue, block letters. To the right of the word is a blue circle with a stylized "S" shape inside. The logo is simple and clean, with a focus on the company name and a recognizable symbol. The color scheme is limited to blue and white.

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Image /page/7/Picture/0 description: The image shows the word "SEMPERIT" in large, bold, blue letters, followed by a blue circle with a stylized "S" inside. The font is sans-serif and appears to be a company logo. The logo is simple and modern.

9.0 Conclusion

There is no significant difference between the two devices. While the two devices use different materials, both devices meet ASTM standards, FDA's requirement for water leak testing, and other considerations. Since the intended use is the same and they have the same technological characteristics, therefore, the new device is substantially equivalent to the predicate.