K Number
K181857
Device Name
Powder Free Nitrile Patient Examination Glove, Blue Colored, Non-Sterile, Low Dermatitis Potential. Tested for Use with Chemotherapy Drugs and Fentanyl Citrate
Date Cleared
2018-11-20

(132 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
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. These gloves were tested for use with chemotherapy drugs and Fentanyl Citrate as per ASTM D6978-05 (Reapproved 2013) Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs. | Chemotherapy Drug and Concentration | Minimum Breakthrough Detection Time in Minutes | |-----------------------------------------|------------------------------------------------| | Carmustine (BCNU) (3.3 mg/ml) | 26.2 | | Cisplatin (1.0 mg/ml) | >240 | | Cyclophosphamide (Cytoxan) (20.0 mg/ml) | >240 | | Cytarabine(100 mg/ml) | >240 | | Dacarbazine (DTIC) (10.0 mg/ml) | >240 | | Doxorubicin Hydrochloride (2.0 mg/ml) | >240 | | Etoposide (20.0 mg/ml) | >240 | | Fluorouracil (50.0 mg/ml) | >240 | | Ifosfamide (50.0 mg/ml) | >240 | | Methotrexate (25.0 mg/ml) | >240 | | Mitomycin C (0.5 mg/ml) | >240 | | Mitoxantrone (2.0 mg/ml) | >240 | | Paclitaxel (Taxol) (6.0 mg/ml) | >240 | | Thiotepa (10.0 mg/ml) | 59.1 | | Vincristine Sulfate (1.0 mg/ml) | >240 | Please note that Carmustine (BCNU) and Thiotepa has low permeation times of 26.2 and 59.1 minutes respectively. Fentanyl Citrate and Concentration Fentanyl Citrate Injection (100 mcg/2ml) Minimum Breakthrough Detection Time in Minutes >240
Device Description
Powder Free Nitrile Patient Examination Glove, Blue Colored, Non-Sterile, Low Dermatitis Potential. Tested for Use with Chemotherapy Drugs and Fentanyl Citrate
More Information

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No
The device is a patient examination glove, and the summary describes its physical properties and testing against chemical permeation, with no mention of AI or ML.

No
The device, a patient examination glove, is intended for contamination prevention, not for treating or diagnosing a disease or condition.

No

The device description clearly states it is a "patient examination glove," which is a protective barrier for the examiner, not a device used to diagnose medical conditions.

No

The device is a physical patient examination glove, not a software application. The description focuses on the material and performance characteristics of the glove.

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

Here's why:

  • Intended Use: The intended use is clearly stated as 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 personal protection during patient examination.
  • IVD Definition: An In Vitro Diagnostic device is defined as a medical device intended to be used in vitro for the examination of specimens, including blood and tissue samples, derived from the human body, solely or principally for the purpose of providing information concerning a physiological or pathological state, or concerning a congenital abnormality, or to monitor therapeutic measures.
  • Lack of Diagnostic Function: The glove does not perform any examination of patient specimens or provide any diagnostic information about a patient's health. Its function is purely protective.
  • Testing Focus: The testing described (permeation by chemotherapy drugs and Fentanyl Citrate) relates to the glove's barrier properties and safety for the user, not to any diagnostic capability.

Therefore, this patient examination glove falls under the category of a medical device, but not specifically 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.

These gloves were tested for use with chemotherapy drugs and Fentanyl Citrate as per ASTM D6978-05 (Reapproved 2013) Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs. chemotherapy drugs and Fentanyl Citrate as per ASTM D6978-05 (Reapproved 2013) Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

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

LZA, LZC, QDO

Device Description

Powder Free Nitrile Patient Examination Glove, Blue Colored, Non-Sterile, Low Dermatitis Potential. Tested for Use with Chemotherapy Drugs and Fentanyl Citrate

Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

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Anatomical Site

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Indicated Patient Age Range

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Intended User / Care Setting

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Description of the training set, sample size, data source, and annotation protocol

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Description of the test set, sample size, data source, and annotation protocol

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Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Tested for use with chemotherapy drugs and Fentanyl Citrate as per ASTM D6978-05 (Reapproved 2013) Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

Key results:

  • Carmustine (BCNU) (3.3 mg/ml): Minimum Breakthrough Detection Time in Minutes: 26.2
  • Cisplatin (1.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Cyclophosphamide (Cytoxan) (20.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Cytarabine(100 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Dacarbazine (DTIC) (10.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Doxorubicin Hydrochloride (2.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Etoposide (20.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Fluorouracil (50.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Ifosfamide (50.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Methotrexate (25.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Mitomycin C (0.5 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Mitoxantrone (2.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Paclitaxel (Taxol) (6.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Thiotepa (10.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: 59.1
  • Vincristine Sulfate (1.0 mg/ml): Minimum Breakthrough Detection Time in Minutes: >240
  • Fentanyl Citrate Injection (100 mcg/2ml): Minimum Breakthrough Detection Time in Minutes: >240

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

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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.

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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.

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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).

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§ 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

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health and Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

November 20, 2018

Kossan International Sdn. Bhd. Cho Sow Fong RA Manager Wisma Kossan, Lot 782, Jalan Sungai Putus Off Batu 3 3/4, Jalan Kapar Klang, 42100 My

Re: K181857

Trade/Device Name: Powder Free Nitrile Patient Examination Glove, Blue Colored, Non-Sterile, Low Dermatitis Potential. Tested for Use with Chemotherapy Drugs and Fentanyl Citrate Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: Class I Product Code: LZA, LZC, QDO

Dated: October 19, 2018 Received: October 22, 2018

Dear Cho Sow Fong:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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.

1

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Elizabeth F. Claverie -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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Indications for Use

510(k) Number (if known)

K181857

Device Name

Powder Free Nitrile Patient Examination Glove, Blue Colored, Non-Sterile, Low Dermatitis Potential. Tested for Use vith Chemotherapy Drugs and Fentanyl Citrate

Indications for Use (Describe)

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.

These gloves were tested for use with chemotherapy drugs and Fentanyl Citrate as per ASTM D6978-05 (Reapproved 2013) Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

Chemotherapy Drug and ConcentrationMinimum Breakthrough Detection Time in Minutes
Carmustine (BCNU) (3.3 mg/ml)26.2
Cisplatin (1.0 mg/ml)>240
Cyclophosphamide (Cytoxan) (20.0 mg/ml)>240
Cytarabine(100 mg/ml)>240
Dacarbazine (DTIC) (10.0 mg/ml)>240
Doxorubicin Hydrochloride (2.0 mg/ml)>240
Etoposide (20.0 mg/ml)>240
Fluorouracil (50.0 mg/ml)>240
Ifosfamide (50.0 mg/ml)>240
Methotrexate (25.0 mg/ml)>240
Mitomycin C (0.5 mg/ml)>240
Mitoxantrone (2.0 mg/ml)>240
Paclitaxel (Taxol) (6.0 mg/ml)>240
Thiotepa (10.0 mg/ml)59.1
Vincristine Sulfate (1.0 mg/ml)>240

Please note that Carmustine (BCNU) and Thiotepa has low permeation times of 26.2 and 59.1 minutes respectively.

Fentanyl Citrate and Concentration Fentanyl Citrate Injection (100 mcg/2ml) Minimum Breakthrough Detection Time in Minutes >240

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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

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