K Number
K182851
Device Name
SkyBreeze Zero Nitrile Powder-Free Exam Glove Tested for Use with Chemotherapy Drugs
Date Cleared
2019-06-26

(259 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Skybreeze Zero Nitrile Powder-Free Exam 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 the following chemotherapy drugs: Cyclophosphamide (20.0 mg/ml), Doxorubicin HCl (2.0 mg/ml), Etoposide (20.0 mg/ml), 5-Fluorouracil (50.0 mg/ml), Paclitaxel (Taxol) (6.0 mg/ml), Cisplatin (1.0 mg/ml), Dacarbazine (10.0 mg/ml), Ifosfamide (50.0 mg/ml), Mitoxantrone (2.0 mg/ml), Vincristine sulfate (1.0 mg/ml), Carmustine (3.3 mg/ml), ThioTEPA (10.0 mg.ml). Warning: Not for Use with: Carmustine, ThioTEPA.
Device Description
The SkyBreeze Zero Nitrile Powder-Free Exam Gloves, Tested for Use with Chemotherapy Drugs are disposable, blue-colored, chlorinated, nitrile, powder-free, textured fingertip, ambidextrous, non-sterile patient examination gloves packed in a cardboard dispenser box.
More Information

Not Found

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

No
This device, the Skybreeze Zero Nitrile Powder-Free Exam Glove, is described as a disposable exam glove intended to prevent contamination between patient and examiner. Its function is protective, not therapeutic; it does not treat or cure a disease or condition.

No
The device, Skybreeze Zero Nitrile Powder-Free Exam Glove, is described as a disposable exam glove intended to prevent contamination, and its performance studies relate to physical properties and resistance to chemotherapy drugs, not to diagnosing medical conditions.

No

The device is a physical medical glove, not a software-only device. The description details the material, physical properties, and testing of a tangible product.

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 protection during medical examinations.
  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, or tissue) to detect diseases, conditions, or infections.
  • Device Description: The description details the physical characteristics of a glove, not a device used for analyzing biological samples.
  • Performance Studies: The performance studies focus on the physical properties of the glove (holes, strength, chemotherapy drug resistance, biocompatibility), not on the accuracy or reliability of diagnostic test results.

The device is a medical glove, which is a type of medical device, but it does not fit the definition of an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Skybreeze Zero Nitrile Powder-Free Exam 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 the following chemotherapy drugs:
• Cyclophosphamide (20.0 mg/ml) No breakthrough up to 240 minutes
• Doxorubicin HCl (2.0 mg/ml) No breakthrough up to 240 minutes
• Etoposide (20.0 mg/ml) No breakthrough up to 240 minutes
• 5-Fluorouracil (50.0 mg/ml) No breakthrough up to 240 minutes
• Paclitaxel (Taxol) (6.0 mg/ml) No breakthrough up to 240 minutes
• Cisplatin (1.0 mg/ml) No breakthrough up to 240 minutes
• Dacarbazine (10.0 mg/ml) No breakthrough up to 240 minutes
• Ifosfamide (50.0 mg/ml) No breakthrough up to 240 minutes
• Mitoxantrone (2.0 mg/ml) No breakthrough up to 240 minutes
• Vincristine sulfate (1.0 mg/ml) No breakthrough up to 240 minutes
• Carmustine (3.3 mg/ml) No breakthrough up to 18.6 minutes
• ThioTEPA (10.0 mg.ml) No breakthrough up to 48.3 minutes
Warning: Not for Use with: Carmustine, ThioTEPA

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

LZA, LZC

Device Description

The SkyBreeze Zero Nitrile Powder-Free Exam Gloves, Tested for Use with Chemotherapy Drugs are disposable, blue-colored, chlorinated, nitrile, powder-free, textured fingertip, ambidextrous, non-sterile patient examination gloves packed in a cardboard dispenser box. The Device follows consensus standards: · ASTM D5151-06 Standard Test Method for Detection of Holes in Medical Gloves · ASTM D6319-10 Standard Specification for Nitrile Examination Gloves for Medical Applications · ASTM D6124-06 Standard Test Method for Residual Powder on Medical Gloves · ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs · ISO 10993-11:2017, Biological evaluation of medical devices - Part 11: Tests for Systemic Toxicity · ISO 10993-10: 2010: Biological evaluation of medical devices - Part 10: Tests for Irritation and Skin Sensitization

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

On the examiner's hand

Indicated Patient Age Range

Not Found

Intended User / Care Setting

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)

Study Type: Performance testing based on ASTM standards.

Key Results:

  • ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs: Meets acceptance criteria for 10 drugs. No breakthrough up to 240 minutes for Cisplatin, Cyclophosphamide, Dacarbazine, Doxorubicin HCL, Etoposide, Fluorouracil, Ifosfamide, Mitoxantrone, Paclitaxel, Vincristine Sulfate. Carmustine (3.3 mg/ml) showed no signs of breakthrough until 18.6 minutes. Thiotepa (10 mg/ml) showed no signs of breakthrough until 48.3 minutes.
  • ASTM D5151-06 Standard Test Method for Detection of Holes in Medical Gloves: Meets the 2.5% AQL requirement for leakage.
  • ASTM D6124-06 Standard Test Method for Residual Powder on Medical Gloves: Residual powder is an average of 0.4 mg/glove, meeting the powder-free limit of

§ 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 contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & 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.

June 26, 2019

O & M Halyard, Inc. Angela Bunn Director Regulatory Affairs 5405 Windward Parkway Alpharetta, Georgia 30004

Re: K182851

Trade/Device Name: SkyBreeze Zero Nitrile Powder-Free Exam Glove Tested for Use with Chemotherapy Drugs Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I Product Code: LZA, LZC Dated: May 23, 2019 Received: May 24, 2019

Dear Angela Bunn:

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/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

For Elizabeth Claverie-Williams, M.S. Assistant Director THT4B2: Disinfection, Reprocessing and Personal Protection Acting Assistant Director. THT4B1: Sterility Devices DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K182851

Device Name

SkyBreeze Zero Nitrile Powder-Free Exam Gloves, Tested for Use with Chemotherapy Drugs

Indications for Use (Describe)

The Skybreeze Zero Nitrile Powder-Free Exam 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 the following chemotherapy drugs:

Tested Chemotherapy Drugs and ConcentrationAverage Breakthrough Detection Time (Minutes)
• Cyclophosphamide (20.0 mg/ml)No breakthrough up to 240 minutes
• Doxorubicin HCl (2.0 mg/ml)No breakthrough up to 240 minutes
• Etoposide (20.0 mg/ml)No breakthrough up to 240 minutes
• 5-Fluorouracil (50.0 mg/ml)No breakthrough up to 240 minutes
• Paclitaxel (Taxol) (6.0 mg/ml)No breakthrough up to 240 minutes
• Cisplatin (1.0 mg/ml)No breakthrough up to 240 minutes
• Dacarbazine (10.0 mg/ml)No breakthrough up to 240 minutes
• Ifosfamide (50.0 mg/ml)No breakthrough up to 240 minutes
• Mitoxantrone (2.0 mg/ml)No breakthrough up to 240 minutes
• Vincristine sulfate (1.0 mg/ml)No breakthrough up to 240 minutes
• Carmustine (3.3 mg/ml)No breakthrough up to 18.6 minutes
• ThioTEPA (10.0 mg.ml)No breakthrough up to 48.3 minutes
Warning: Not for Use with: Carmustine, ThioTEPA

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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510(k) Summary

| Date Summary

was PreparedJune 25, 2019
510(k) SubmitterO & M Halyard, Inc.
5405 Windward Parkway
Alpharetta, GA 20004
Primary Contact for
this 510(k) SubmissionAngela L. Bunn, Director Regulatory Affairs
O & M Halyard, Inc.
5405 Windward Parkway, Alpharetta, GA 30004 US
(470) 448-5158 [voice]
angela.bunn@hyh.com
Device Trade NameSkyBreeze Zero Nitrile Powder-Free Exam Gloves, Tested for Use
with Chemotherapy Drugs
Device Common NameMedical Exam Gloves
Device Product Code
and Classification NameLZA, LZC
Class I, 21 CFR §880.6250
Patient Examination Glove
Predicate DeviceK180646
Halyard Lavender Nitrile Powder-Free Exam Gloves Tested for Use
with Chemotherapy Drugs
Subject Device DescriptionThe SkyBreeze Zero Nitrile Powder-Free Exam Gloves, Tested for
Use with Chemotherapy Drugs are disposable, blue-colored,
chlorinated, nitrile, powder-free, textured fingertip, ambidextrous,
non-sterile patient examination gloves packed in a cardboard
dispenser box. The Device follows consensus standards:
· ASTM D5151-06 Standard Test Method for Detection of Holes in
Medical Gloves
· ASTM D6319-10 Standard Specification for Nitrile Examination
Gloves for Medical Applications
· ASTM D6124-06 Standard Test Method for Residual Powder on
Medical Gloves
· ASTM D6978-05 Standard Practice for Assessment of Resistance
of Medical Gloves to Permeation by Chemotherapy Drugs
· ISO 10993-11:2017, Biological evaluation of medical devices -
Part 11: Tests for Systemic Toxicity
· ISO 10993-10: 2010: Biological evaluation of medical devices -
Part 10: Tests for Irritation and Skin Sensitization
Indications for UseThe Skybreeze Zero Nitrile Powder-Free Exam 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 the following chemotherapy drugs:
Cyclophosphamide (20.0 mg/ml) No breakthrough up to 240 minutes Doxorubicin HCI (2.0 mg/ml) No breakthrough up to 240 minutes Etoposide (20.0 mg/ml) No breakthrough up to 240 minutes 5-Fluorouracil (50.0 mg/ml) No breakthrough up to 240 minutes Paclitaxel (Taxol) (6.0 mg/ml) No breakthrough up to 240 minutes Cisplatin (1.0 mg/ml) No breakthrough up to 240 minutes Dacarbazine (10.0 mg/ml) No breakthrough up to 240 minutes Ifosfamide (50.0 mg/ml) No breakthrough up to 240 minutes Mitoxantrone (2.0 mg/ml) No breakthrough up to 240 minutes Vincristine sulfate (1.0 mg/ml) No breakthrough up to 240 minutes Carmustine (3.3 mg/ml) No breakthrough up to 18.6 minutes ThioTEPA (10.0 mg.ml) No breakthrough up to 48.3 minutes Warning: Not for Use with: Carmustine, ThioTEPA
Summary of comparison of
technological characteristicsBoth the subject device and the predicate device are powder-free non-sterile
nitrile exam gloves tested for resistance to permeation by chemotherapy
drugs.

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Technological Characteristics Comparison Table
Subject DevicePredicate Device K180646Comparison
FDA Product CodeLZC, LZALZC, LZASame
FDA ClassificationClass IClass ISame
Regulation Number880.6250880.6250Same
Common NameMedical Exam GloveMedical Exam GloveSame
Device Trade NameSkyBreeze Zero Nitrile Powder-
Free Exam Gloves Tested for
Use with Chemotherapy DrugsHalyard Lavender Nitrile Powder-
Free Exam Gloves Tested for Use
with Chemotherapy DrugsSimilar
Intended UseThe Skybreeze Zero Nitrile
Powder-Free Exam 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 listed on the
label.The Halyard Lavender Nitrile-
Powder-Free Exam 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 listed on the label.Same
Technological
CharacteristicsBlue-colored, 9.5-inch, 0.07 mm
thick at palm, nitrile, powder-free,
textured fingertip, ambidextrous,
non- sterile patient examination
glove.Lavender-colored, 9.5-inch, .058
mm thick at palm, nitrile, powder-
free, textured fingertip,
ambidextrous, non- sterile patient
examination glove.Similar
Sizes of glovesExtra Small (XS)
Small (S)
Medium (M)
Large (L)
Extra Large (XL)Extra Small (XS)
Small (S)
Medium (M)
Large (L)
Extra Large (XL)Similar
dimensions
with minor
differences in
fingers and
palm
thickness.
Thickness at Fingers0.10 mm (XS)
0.10 mm (S)
0.10 mm (MS)
0.10 mm (L)
0.10 mm (XL)0.078 mm (XS)
0.078 (S)
0.078 mm (MS)
0.078 mm (L)
0.078 mm (XL)thickness.
Thickness at Palm0.07 mm (XS)
0.07 mm (S)
0.07 mm (M)
0.07 mm (L)
0.07 mm (XL)0.058 (XS)
0.058 (S)
0.058 (M)
0.058 (L)
0.058 (XL)
Width of Palm70 mm (XS)
80 mm (S)
95 mm (M)
110 mm (L)
120 mm (XL)70 mm (XS)
80 mm (S)
95 mm (M)
110 mm (L)
120 mm (XL)
Length of Palm240 mm (XS)
240 mm (S)
240 mm (M)
240 mm (L)
240 mm (XL)242 mm (XS)
242 mm (S)
242 mm (M)
242 mm (L)
242 mm (XL)
TextureTextured fingertipsTextured fingertipsSame
SterilityNon-SterileNon-SterileSame
Shelf lifeNo Shelf life is being claimed at
this time.No Shelf life is being claimed at
this time.Same
BiocompatibilityBased ISO 10993 – 11 (2017)
Biological evaluation of Medical
devices - Test for Systemic
Toxicity, the test article was
considered non-toxic.Based ISO 10993 – 11 (2017)
Biological evaluation of Medical
devices - Test for Systemic
Toxicity, the test article was
considered non-toxic.Same
Based on ISO 10993 – 10
(2010): Under the conditions of
the study, not a primary skin
irritant;
Under conditions of the study,
not a contact sensitizer.Based on ISO 10993 – 10 (2010):
Under the conditions of the study,
not a primary skin irritant;
Under conditions of the study, not
a contact sensitizer.

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6

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Performance Data
StandardResults
Subject DeviceResults
K180646Remarks
ASTM D6978-05
Standard Practice for
Assessment of Resistance of
Medical Gloves to
Permeation by
Chemotherapy DrugsResult: Meets acceptance
criteria for 10 drugs.Result: Meets acceptance
criteria for 10 drugs.Similar with different
breakthrough times
for Carmustine and
Thiotepa.
No breakthrough up to 240
minutes:No breakthrough up to
240 minutes:
Cisplatin (1 mg/ml) No
breakthrough up to 240
minutesCisplatin (1 mg/ml) No
breakthrough up to 240
minutes
Cyclophosphamide (20
mg/ml) No breakthrough up
to 240 minutesCyclophosphamide (20
mg/ml) No breakthrough
up to 240 minutes
Dacarbazine (10 mg/ml)
No breakthrough up to 240
minutesDacarbazine (10 mg/ml)
No breakthrough up to
240 minutes
Doxorubicin HCL (2 mg/ml)
No breakthrough up to 240
minutesDoxorubicin HCL (2
mg/ml) No breakthrough
up to 240 minutes
Etoposide (20 mg/ml) No
breakthrough up to 240
minutesEtoposide (20 mg/ml) No
breakthrough up to 240
minutes
Fluorouracil (50 mg/ml) No
breakthrough up to 240
minutesFluorouracil (50 mg/ml)
No breakthrough up to
240 minutes
Ifosfamide (50 mg/ml) No
breakthrough up to 240
minutesIfosfamide (50 mg/ml) No
breakthrough up to 240
minutes
Mitoxantrone (2 mg/ml) No
breakthrough up to 240
minutesMitoxantrone (2 mg/ml)
No breakthrough up to
240 minutes
Paclitaxel (6 mg/ml) No
breakthrough up to 240
minutesPaclitaxel (6 mg/ml) No
breakthrough up to 240
minutes
Vincrinstine Sulfate (1
mg/ml) No breakthrough up
to 240 minutesVincrinstine Sulfate (1
mg/ml) No breakthrough
up to 240 minutes
Carmustine (3.3 mg/ml)
showed no signs of
breakthrough until 18.6
minutesCarmustine (3.3 mg/ml)
showed no signs of
breakthrough until 0.3
minutes
Thiotepa (10 mg/ml)
showed no signs of
breakthrough until 48.3
minutesThiotepa (10 mg/ml)
showed no signs of
breakthrough until 30.9
minutes.
ASTM D5151-06
Standard Test Method for
Detection of Holes in Medical
GlovesTesting of the subject
device shows it meets the
2.5% AQL requirement in
the standards for leakage.
The device meets the
acceptance criteria of the
standard.Testing of the subject
device shows it meets the
2.5% AQL requirement in
the standards for leakage.
The device meets the
acceptance criteria of the
standard.Same
ASTM D6124-06
Standard Test Method for
Residual Powder on Medical
GlovesResidual powder on the
subject device is an
average of 0.4 mg/glove
within the powder-free limit
of