K Number
K162095
Date Cleared
2016-11-02

(97 days)

Product Code
Regulation Number
880.6250
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

A patient examination gloves is a disposable device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. This glove is also tested for use against Chemotherapy Drugs. The Chemotherapy Drugs and its permeation time is listed as below.

Device Description

Non-Sterile, Powder Free Blue Nitrile Patient Examination Gloves, Tested for use with Chemotherapy Drugs (Original Blue, Cobalt Blue) meets all the current specifications listed under the ASTM Specification D6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application and D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and FDA 21 CFR 880.6250. The principle operation and mechanism of this device is to prevent contamination between patient and examiner and this principle is achieved through testing of barrier, physical properties and other testing stated in the performance data. This device is for over-the counter single use.

AI/ML Overview

This document is a 510(k) Pre-market Notification for medical gloves, focusing on their resistance to chemotherapy drugs. It details the performance of "Non-Sterile, Powder Free Nitrile Examination Gloves, Tested For Use With Chemotherapy Drugs (Original Blue, Cobalt Blue)" against a range of chemotherapy agents.

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria for chemotherapy drug permeation are defined by the "Average Breakthrough Detection Time" for each drug. While the specific numerical acceptance criteria (e.g., minimum time) are not explicitly stated as distinct "criteria" separate from the results, the implication is that the longer the breakthrough time, the better the performance. For many drugs, a breakthrough time of "> 240 minutes" is presented, suggesting this is a desirable outcome or a de facto acceptance benchmark for long-term protection. The device performance is the directly measured average breakthrough detection time for each drug.

Below are the tables summarizing the performance for both "Original Blue" and "Cobalt Blue" glove variations, as tested against various chemotherapy drugs.

Device Name: Non-Sterile, Powder Free Nitrile Examination Gloves, Tested For Use With Chemotherapy Drugs - Original Blue

Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time (minutes)
Carboplatin, 10 mg/ml> 240
Carmustine (3.3 mg/ml)1.84
Cisplatin (BCNU), 1.0 mg/ml> 240
Cyclophosphamide (Cytoxan), 20.0 mg/ml> 240
Dacarbazine (DTIC), 10.0 mg/ml> 240
Doxorubicin Hydrochloride, 2.0 mg/ml> 240
Etoposide (Toposar), 20.0 mg/ml> 240
Fluorouracil, 50.0 mg/ml> 240
Ifosfamide, 50.0 mg/ml> 240
Methotrexate, 25 mg/ml> 240
Mitomycin C, 0.5 mg/ml> 240
Mitoxantrone, 2 mg/ml> 240
Paclitaxel (Taxol), 6.0 mg/ml> 240
ThioTEPA (10.0 mg/ml)0.76
Vincristine Sulfate, 1.0 mg/ml> 240
Warning for drugs with extremely low permeation time:Carmustine (3.3 mg/ml): 1.84 minutes
ThioTEPA (10.0 mg/ml): 0.76 minutes

Device Name: Non-Sterile, Powder Free Nitrile Examination Gloves, Tested For Use With Chemotherapy Drugs - Cobalt Blue

Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time (minutes)
Carboplatin, 10 mg/ml> 240
Carmustine (3.3 mg/ml)1.82
Cisplatin (BCNU), 1.0 mg/ml> 240
Cyclophosphamide (Cytoxan), 20.0 mg/ml> 240
Dacarbazine (DTIC), 10.0 mg/ml> 240
Doxorubicin Hydrochloride, 2.0 mg/ml> 240
Etoposide (Toposar), 20.0 mg/ml> 240
Fluorouracil, 50.0 mg/ml> 240
Ifosfamide, 50.0 mg/ml> 240
Methotrexate, 25 mg/ml> 240
Mitomycin C, 0.5 mg/ml> 240
Mitoxantrone, 2 mg/ml> 240
Paclitaxel (Taxol), 6.0 mg/ml> 240
ThioTEPA (10.0 mg/ml)0.93
Vincristine Sulfate, 1.0 mg/ml> 240
Warning for drugs with extremely low permeation time:Carmustine (3.3 mg/ml): 1.82 minutes
ThioTEPA (10.0 mg/ml): 0.93 minutes

In addition to chemotherapy drug permeation, the gloves were also tested against other specifications, including:

CharacteristicStandardAcceptance CriteriaDevice Performance (Original Blue)Device Performance (Cobalt Blue)
DimensionASTM D6319-10Minimum 240mm lengthMinimum 240mmMinimum 240mm
Physical PropertiesASTM D6319-10Meets standard requirementsMeetsMeets
ThicknessASTM D6319-10Finger 0.07-0.10mm (Predicate 1), 0.10min (Predicate 2); Palm 0.07-0.09mm; Cuff 0.06-0.08mm (Predicate 1), Not specified (Cuff, Predicate 2)Finger 0.09-0.14mm; Palm 0.07-0.10mm; Cuff 0.06-0.09mmFinger 0.10min; Palm 0.07-0.09mm; Cuff 0.05-0.08mm
Powder-freeASTM D6124-06 (<2mg/glove)Meets standard requirements (less than 2mg/glove)MeetsMeets
Bio-compatibilityISO 10993-10 (2010), Consumer Product Safety CommissionNot a primary skin irritant; Not a contact sensitizerUnder the condition of the study the device is non-irritant; Under the condition of the study the device is non-sensitizerUnder the condition of the study the device is non-irritant; Under the condition of the study the device is non-sensitizer
Water tightnessASTM D5151-06Passes (1000ml)PassesPasses

2. Sample Size Used for the Test Set and Data Provenance

The document does not explicitly state the specific sample sizes used for testing each individual chemotherapy drug permeation or other properties. However, it does state that the device "meets all the current specifications listed under the ASTM Specification D6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application and D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and FDA 21 CFR 880.6250." These ASTM standards would typically define the appropriate sample sizes and testing methodologies.

The data provenance is not specified, but the submission is from "YTY Industry (Manjung) Sdn. Bhd., Malaysia," suggesting the tests were likely conducted on products manufactured or supervised by this Malaysian entity. The tests appear to be a prospective evaluation of the device's performance against established standards.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and the Qualifications of Those Experts

This document describes performance testing of physical properties and chemical permeation resistance of gloves, not diagnostic or clinical interpretation. Therefore, the concept of "experts used to establish ground truth" as it would apply to image analysis or clinical diagnosis is not applicable here. The "ground truth" is established by adherence to recognized industrial standards (ASTM D6319-10 and D6978-05) and FDA regulations. These standards define the scientific methods and procedures for evaluating glove performance.

4. Adjudication Method for the Test Set

Not applicable. This is not a study involving human interpretation or subjective assessment that would require adjudication.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was Done

No, an MRMC comparative effectiveness study was not done. This type of study is relevant for evaluating the impact of a device (often AI-based) on human reader performance in tasks like diagnostic interpretation. This document pertains to the physical and chemical performance of medical gloves, not assistive diagnostic technology.

6. If a Standalone (i.e. algorithm only without human-in-the loop performance) was Done

Yes, a standalone performance assessment was done. The entire study described is a standalone evaluation of the glove's performance against various physical and chemical challenges, without human-in-the-loop interaction in the context of diagnostic interpretation. The breakthrough detection times and physical properties are direct measurements of the device's inherent characteristics.

7. The Type of Ground Truth Used

The ground truth used is based on established industry standards and scientific testing procedures. Specifically:

  • ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs: This standard outlines the methodology for determining the breakthrough detection time of chemotherapy drugs through glove material.
  • ASTM Specification D6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application: This standard sets specifications for physical properties like dimensions, physical performance, and powder content.
  • ISO 10993-10 (2010) and Consumer Product Safety Commission II, Part 1500: These standards govern biocompatibility testing (primary skin irritation and dermal sensitization).
  • ASTM D5151-06: This standard relates to water tightness testing.

The results obtained through these standardized testing methods serve as the "ground truth" for the device's performance.

8. The Sample Size for the Training Set

Not applicable. This device is a medical glove, not an AI or machine learning algorithm. Therefore, there is no "training set" in the context of an algorithm.

9. How the Ground Truth for the Training Set Was Established

Not applicable, as there is no "training set" for this type of device.

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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" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized human figure or a caduceus, with three overlapping profiles facing to the right.

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

November 2, 2016

YTY Industry (Manjung) Sdn. Bhd., Punitha Samy Deputy Manager-DC/RA Lot 1422-1424 Batu 10 Lekir Sitiawan, Perak 32020 MY

Re: K162095

Trade/Device Name: Non-sterile, Powder Free Nitrile Examination Gloves, Tested For Use With Chemotherapy Drugs (Original Blue, Cobalt Blue) Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LZA, LZC Dated: September 19, 2016 Received: September 23, 2016

Dear Punitha Samy:

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 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

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the quality systems (OS) 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

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K162095

Device Name

Non-Sterile, Powder Free Nitrile Examination Gloves Tested For Use With Chemotherapy Drugs - Original Blue

Indications for Use (Describe)

A patient examination gloves is a disposable device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. This glove is also tested for use against Chemotherapy Drugs. The Chemotherapy Drugs and its permeation time is listed as below.

Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time
Carboplatin, 10 mg/ml> 240 minutes
Carmustine (3.3 mg/ml)1.84 minutes
Cisplatin (BCNU), 1.0 mg/ml> 240 minutes
Cyclophosphamide (Cytoxan), 20.0 mg/ml> 240 minutes
Dacarbazine (DTIC), 10.0 mg/ml> 240 minutes
Doxorubicin Hydrochloride, 2.0 mg/ml> 240 minutes
Etoposide (Toposar), 20.0 mg/ml> 240 minutes
Fluorouracil, 50.0 mg/ml> 240 minutes
Ifosfamide , 50.0 mg/ml> 240 minutes
Methotrexate, 25 mg/ml> 240 minutes
Mitomycin C, 0.5 mg/ml> 240 minutes
Mitoxantrone, 2 mg/ml> 240 minutes
Paclitaxel (Taxol), 6.0 mg/ml> 240 minutes
ThioTEPA (10.0 mg/ml)0.76 minutes
Vincristine Sulfate, 1.0 mg/ml> 240 minutes

The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 1.84 minutes ThioTEPA (10.0 mg/ml): 0.76 minutes

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K162095

Device Name

Non-Sterile, Powder Free Nitrile Examination Gloves Tested For Use With Chemotherapy Drugs - Cobalt Blue

Indications for Use (Describe)

A patient examination gloves is a disposable device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. This glove is also tested for use against Chemotherapy Drugs. The Chemotherapy Drugs and its permeation time is listed as below.

Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time
Carboplatin, 10 mg/ml> 240 minutes
Carmustine (3.3 mg/ml)1.82 minutes
Cisplatin (BCNU), 1.0 mg/ml> 240 minutes
Cyclophosphamide (Cytoxan), 20.0 mg/ml> 240 minutes
Dacarbazine (DTIC), 10.0 mg/ml> 240 minutes
Doxorubicin Hydrochloride, 2.0 mg/ml> 240 minutes
Etoposide (Toposar), 20.0 mg/ml> 240 minutes
Fluorouracil, 50.0 mg/ml> 240 minutes
Ifosfamide , 50.0 mg/ml> 240 minutes
Methotrexate, 25 mg/ml> 240 minutes
Mitomycin C, 0.5 mg/ml> 240 minutes
Mitoxantrone, 2 mg/ml> 240 minutes
Paclitaxel (Taxol), 6.0 mg/ml> 240 minutes
ThioTEPA (10.0 mg/ml)0.93 minutes
Vincristine Sulfate, 1.0 mg/ml> 240 minutes

The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 1.82 minutes ThioTEPA (10.0 mg/ml): 0.93 minutes

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

{5}------------------------------------------------

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Druq Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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K162095

510 (K) SUMMARY SHEETS

1.0510 (K) SUMMARY
2.0SubmitterYTY INDUSTRY (MANJUNG) SDN. BHD.,Lot 1422-1424, Batu 10 Lekir32020 Sitiawan, PerakMalaysia
Tel605-6908533
Fax605-6908533
Name of Contact PersonPunitha Samy (Ms)E-mail: punitha.samy@ytygroup.com.my
Date Summary PreparedNovember 2, 2016
3.0Name of Device
Trade Name:Non-Sterile, Powder Free Blue Nitrile Patient Examination Gloves,Tested for use with Chemotherapy Drugs (Original Blue, Cobalt Blue)
Common Name:Nitrile Examination Gloves
Classification Name:Patient Examination Gloves, Powder Free
Device Classification:I
Regulation No. & Classification Name: Patient Examination Gloves Specialty (21 CFR 880.6250 product code LZC)Patient Examination Gloves (21 CFR 880.6250 product code LZA)

Panel:

General Hospital

4.0 Identification of The Legally Marketed Devices that equivalency is claimed:

Device NameDermagrip Powder FreeBlue Nitrile PatientExamination Gloves, Non-Sterile, Tested for use withChemotherapy DrugsNitrile Powder FreeExamination Gloves Testedfor Use withChemotherapy Drugs -Violet Blue (VBLU)
Predicate 510(K)number:K141982K151997
Device Classification:11
Product Code:LZCLZC

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5.0 Description of The Device

Non-Sterile, Powder Free Blue Nitrile Patient Examination Gloves, Tested for use with Chemotherapy Drugs (Original Blue, Cobalt Blue) meets all the current specifications listed under the ASTM Specification D6319-10, Standard Specification for Nitrile Examination Gloves for Medical Application and D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and FDA 21 CFR 880.6250. The principle operation and mechanism of this device is to prevent contamination between patient and examiner and this principle is achieved through testing of barrier, physical properties and other testing stated in the performance data. This device is for over-the counter single use.

6.0 The Intended Use of Glove

A patient examination gloves is a disposable device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. This glove is also tested for use against Chemotherapy Drugs. The Chemotherapy Drugs and its permeation time is listed as below.

CharacteristicConcentrationK162095Original BlueK162095Cobalt Blue
Average Breakthrough Detection Time (minutes)
Carboplatin10mg/ml> 240> 240
*Carmustine3.3mg/ml1.841.82
Cisplatin (BCNU)1.0mg/ml> 240> 240
Cyclophosphamide(Cytoxan)20.0mg/ml> 240> 240
Dacarbazine (DTIC)10.0mg/ml> 240> 240
DoxorubicinHydrochloride2.0mg/ml> 240> 240
Etoposide (Toposar)20.0mg/ml> 240> 240
Fluorouracil50.0mg/ml> 240> 240
Ifosfamide50.0mg/ml> 240> 240
Methotrexate25mg/ml> 240> 240
Mitomycin C0.5mg/ml> 240> 240
Mitoxantrone2 mg/ml> 240> 240
Paclitaxel (Taxol)6.0mg/ml> 240> 240
Thiotepa10.0mg/ml0.760.93
Vincristine Sulfate1.0mg/ml> 240> 240
Warning Statement*WARNING: Please note that the following drugs have extremely low permeation times: Carmustine: 1.84 minutes and ThioTepa: 0.76 minutes. NOT TO BE USED WITH CARMUSTINE OR THIOTEPA* WARNING: Please note that the following drugs have extremely low permeation times: Carmustine: 1.82 minutes and ThioTepa: 0.93 minutes. NOT TO BE USED WITH CARMUSTINE OR THIOTEPA

Sec 1 Sum Page 2 of 8

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7.0 Summary of the Technological Characteristic of the Device compared to the Predicate Device for substantial equivalent discussion

There is no difference in technology characteristic compared to the predicate device. Gloves are made from nitrile latex compound. Non-Sterile, Powder Free Blue Nitrile Patient Examination Gloves, Tested for use with Chemotherapy Drugs (Original Blue, Cobalt Blue) have the below technological characteristic compared to ASTM or Equivalent standards.

This glove is compliant with the ASTM standards and similar to the predicate device in the market, which has a glove thickness less than 0.10mm and length less than 270mm. The chemotherapy claim is similar to Predicate.

Table 1 – Predicate 1
CharacteristicStandardsDevice Performance
Predicate K162095 – Original Blue
510(K) NumberK141982 K162095
DimensionASTM D6319-10Min 240mm Min 240mm
Physical PropertiesASTM D6319-10Meets Meets
ThicknessASTM D6319-10Finger 0.07 – 0.10mm 0.09 – 0.14mmPalm 0.07 – 0.09mm 0.07 - 0.10mmCuff 0.06 – 0.08mm 0.06 – 0.09mm
Powder-freeASTM D6124-06(<2mg/glove)Meets Meets
Bio-compatibilityPrimary skinirritationISO 10993-10 (2010)Dermal SensitizationISO 10993-10 (2010)Not a primary skin irritantunder the conditions ofthe study Under the condition ofthe study the device isnon-irritantNot a contact sensitizerunder the conditions ofthe study Under the condition ofthe study the device isnon-sensitizer
Table 1 - Predicate 1
---------------------------

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CharacteristicTested accordingto ASTM D6978-05Device Performance
ConcentrationPredicate-K141982K162095– Original Blue
Average Breakthrough Detection Time (minutes)
Carboplatin10mg/ml-> 240
*Carmustine3.3mg/ml151.84
Cisplatin1.0mg/ml> 240> 240
Cyclophosphamide(Cytoxan)20.0mg/ml> 240> 240
Dacarbazine (DTIC)10.0mg/ml> 240> 240
DoxorubicinHydrochloride2.0mg/ml> 240> 240
Etoposide (Toposar)20.0mg/ml> 240> 240
Fluorouracil50.0mg/ml> 240> 240
Ifosfamide (Ifex)50.0mg/ml> 240> 240
Methotrexate25mg/ml-> 240
Mitomycin C0.5mg/ml-> 240
Mitoxantrone2 mg/ml> 240> 240
Paclitaxel (Taxol)6.0mg/ml> 240> 240
Thiotepa10.0mg/ml2.00.76
Vincristine Sulfate1.0mg/ml> 240> 240
Warning Statement*WARNING: Please note thatthe following drugs haveextremely low permeationtimes: Carmustine (BCNU) :15 minutes and Thiotepa : 2minutes*WARNING: Please note thatthe following drugs haveextremely low permeationtimes: Carmustine: 1.84minutes and ThioTepa: 0.76minutes. NOT TO BE USEDWITH CARMUSTINE ORTHIOTEPA

Table 2 – Predicate 1

Table 3 – Predicate 2

CharacteristicStandardsDevice Performance
PredicateK162095 – Cobalt Blue
510(K) NumberK151997K162095
DimensionASTM D6319-10Min 240mmMin 240mm
Physical PropertiesASTM D6319-10MeetsMeets
ThicknessFinger0.10min0.10min
Palm0.07 – 0.09mm0.07 – 0.09mm
Cuff0.05 - 0.08mm
Powder-freeASTM D6124-06(< 2mg/glove)MeetsMeets
Bio-compatibilityPrimary skinirritationISO 10993-10(2010)Not a primary skin irritant underthe conditions of the studyUnder the condition of thestudy the device is non-irritant
DermalSensitizationISO 10993-10(2010)Not a contact sensitizer underthe conditions of the studyUnder the condition of thestudy the device is non-sensitizer

Sec 1 Sum Page 4 of 8

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Table 4 - Predicate 2
CharacteristicTested according toASTM D6978-05Device Performance
Predicate - K151997K162095 – Cobalt Blue
Average Breakthrough Detection Time (minutes)
ConcentrationPredicateCurrent
Carboplatin10mg/ml-> 240
*Carmustine3.3mg/ml10.21.82
Cisplatin1.0mg/ml> 240> 240
Cyclophosphamide(Cytoxan)20.0mg/ml> 240> 240
Dacarbazine (DTIC)10.0mg/ml> 240> 240
DoxorubicinHydrochloride2.0mg/ml> 240> 240
Etoposide (Toposar)20.0mg/ml> 240> 240
Fluorouracil50.0mg/ml> 240> 240
Ifosfamide (Ifex)50.0mg/ml-> 240
Methotrexate25mg/ml> 240> 240
Mitomycin C0.5mg/ml> 240> 240
Mitoxantrone2 mg/ml-> 240
Paclitaxel (Taxol)6.0mg/ml> 240> 240
Thiotepa10.0mg/ml30.20.93
Vincristine Sulfate1.0mg/ml> 240> 240
Warning Statement* Please note thatCarmustine and Thiotepahave extremely lowpermeation times of 10.2minutes and 30.2minutes* WARNING: Please note thatthe following drugs haveextremely low permeationtimes: Carmustine: 1.82minutes and ThioTepa: 0.93minutes. NOT TO BE USEDWITH CARMUSTINE ORTHIOTEPA

Table 4 – Predicate 2

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Table 5 Device Performance
CharacteristicsPredicateK141982K162095Original BluePredicateK151997K162095Cobalt BlueMedical GloveManual (1661) andStandards
Water tightness(1000ml)PassesPassesPassesPassesASTM D5151-06
ColorBlueOriginal BlueViolet BlueCobalt BlueASTM D6319-10(Reapproved 2015)
MaterialNitrileNitrileNitrileNitrileLabeling
SizeExtra SmallSmallMediumLargeExtra LargeExtra SmallSmallMediumLargeExtra LargeExtra SmallSmallMediumLargeExtra LargeExtra SmallSmallMediumLargeExtra LargeLabeling
TextureFinger TexturedFinger TexturedFingerTexturedFingerTextured
Single UseSingle UseSingle UseSingle UseSingle UseLabeling
Bio-compatibilityPassesPassesPassesPassesPrimary Skin Irritation
Not primary skinirritant under theconditions of the study.Under the condition of thestudy the device is non-irritantUnder the condition ofthe study the device isnon-irritantUnder the condition of thestudy the device is non-irritantISO 10993-10: 2010(E)Test for Irritation andSkin Sensitization &Consumer ProductSafety Commission II,Part 1500
PassesNot a contact sensitizerunder the conditions ofthe study.PassesUnder the condition of thestudy the device in non-sensitizerPassesUnder the condition ofthe study the device innon-sensitizerPassesUnder the condition of thestudy the device in non-sensitizerDermal Sensitization -ISO 10993-10(E) &Consumer ProductSafety Commission,Title 16, Chapter II,Part 1500.3 (c) (4)

Tahle 5

Sec 1 SUM Page 6 of 8

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Indications for UseA patientExamination glove is amedical device intendedfor medical purposesthat is worn on theexaminer's hand toprevent contaminationbetween patient andexaminer.A patient examination gloves is adisposable device intended formedical purpose that is worn on theexaminer's hand or finger toprevent contamination betweenpatient and examiner. This glove isalso tested for use againstChemotherapyDrugs. The Chemotherapy Drugsand its permeation time is listed asbelow.Is nonsteriledisposable deviceintended for medicalpurpose that is worn onthe examiner's hand toprevent contaminationbetween patient andexaminer. It is alsotested to be used againstChemotherapy Drugs.A patient examination gloves is adisposable device intended formedical purpose that is worn on theexaminer's hand orfinger to prevent contaminationbetween patient and examiner. Thisglove is also tested for use againstChemotherapyDrugs. The Chemotherapy Drugsand its permeation time is listed asbelow.This gloves meet allcurrent specificationslisted under ASTMspecifications D6319-10
*Carmustine3.3mg/ml15Cisplatin 1.0mg/ml >240CyclophosphamideCytoxan) 20.0mg/ml >Tested ChemotherapyDrug And ConcentrationCarmustine (3.3 mg/ml)10.2 minutesCisplatin (1.0 mg/ml) >240minutesCyclophosphamide (20mg/ml) >240 minutesDacarbazine (10.0 mglml)>240 minutesDoxorubicinHydrochloride (2.0 mg/ml)>240 minutesEtoposide (20.0 mg/ml)>240 minutesTested ChemotherapyDrug And Concentration
240Dacarbazine (DTIC)10.0mg/ml> 240DoxorubicinHydrochloride 2.0mg/ml>240Etoposide (Toposar)20.0mg/ml> 240Carboplatin, 10 mg/mlCarmustine (3.3 mg/ml)Cisplatin (BCNU), 1.0mg/mlCyclophosphamide(Cytoxan), 20.0 mg/mlDacarbazine (DTIC), 10.0mg/mlFluorouracil (50.0 mg/ml)Methotrexate (25 mg/ml)Carboplatin, 10mg/mlCarmustine (3.3 mg/ml)Cisplatin (BCNU), 1.0mg/mlCyclophosphamide(Cytoxan), 20.0 mg/mlDacarbazine (DTIC), 10.0mg/ml
Fluorouracil 50.0mg/ml>240Ifosfamide (Ifex)50.0mg/ml> 240DoxorubicinHydrochloride, 2.0 mg/mlEtoposide (Toposar), 20.0mg/mlDoxorubicinHydrochloride, 2.0 mg/mlEtoposide (Toposar), 20.0mg/ml
Mitoxantrone 2 mg/ml>240Paclitaxel (Taxol)6.0mg/ml> 240Thiotepa 10.0mg/ml 2.0Fluorouracil, 50.0 mg/mlIfosfamide , 50.0 mg/mlMethotrexate, 25 mg/mlMitomycin C, 0.5 mg/mlMitoxantrone, 2 mg/mlMitomycin C (0.5 mg/ml)>240 minutesPaclitaxel (6.0 mg/ml)>240 minutesThiotepa (10.0 mg/ml)30.2 minutesVincristine Sulfate (1.0mg/ml) >240 minutesPlease note thatCarmustine and Thiotepahave extremely lowFluorouracil, 50.0 mg/mlIfosfamide , 50.0 mg/mlMethotrexate, 25 mg/mlMitomycin C, 0.5 mg/mlMitoxantrone, 2 mg/ml
Vincristine Sulfate1.0mg/ml> 240Warning StatementPaclitaxel (Taxol), 6.0mg/mlThioTEPA (10.0 mg/ml)Vincristine Sulfate, 1.0Paclitaxel (Taxol), 6.0mg/mlThioTEPA (10.0 mg/ml)
*WARNING: Please notethat the following drugshave extremely lowmg/mlThe following chemotherapy drugs andmg/mlThe following chemotherapy drugs and
permeation times:Carmustine (BCNU) : 15minutes and Thiotepa : 2minutesconcentration have extremely lowpermeation time.Carmustine (3.3 mg/ml): 1.84 minThioTEPA (10.0 mg/ml): 0.76 minconcentration have extremely lowpermeation time.Carmustine (3.3 mg/ml): 1.82 minThioTEPA (10.0 mg/ml): 0.93 min
AverageBreakthroughDetectionTimeAverageBreakthroughDetectionTime
>240 min>240 min
1.84 min1.82 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
>240 min>240 min
0.76 min0.93 min
>240 min>240 min

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

The non-clinical tests performance data support a determination of substantial equivalence is the same as and in compliance to ASTM requirements.

9.0 Conclusion

The conclusions drawn from the intended uses, technological characteristics and non-clinical tests demonstrate that the subject device is substantially equivalent to the predicate device K141982 and K151997.

Sec 1 SUM Page 8 of 8

§ 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.