K Number
K183562
Device Name
Powder-Free Nitrile Examination Glove (White Colored, Blue Colored, and Black Colored) Tested for Use with Chemotherapy Drugs
Date Cleared
2019-10-23

(307 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
A powder-free 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. In addition, the glove was tested for use with chemotherapy drugs in accordance with ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs: The following chemotherapy drugs have been tested with the white glove: Cyclophosphamide (Cytoxan) 20.0mg/ml > 240 Doxorubicin Hydrochloride 2.0mg/ml > 240 Etoposide (Toposar) 20.0mg/ml > 240 Fluorouracil 50.0mg/ml > 240 Paclitaxel (Taxol) 6.0mg/ml > 240 Cisplatin 1.0mg/ml > 240 Dacarbazine (DTIC) 10.0mg/ml > 240 Carmustine (BCNU) 3.3mg/ml 11.2 Thiotepa (THT) 10.0mg/ml 25.2 *Please note that the following 2 drugs have extremely low permeation times: 1. Carmustine: 11.2 minutes 2. Thiotepa: 25.2 minutes Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT). The following chemotherapy drugs have been tested with the blue glove: Cyclophosphamide (Cytoxan) 20.0mg/ml > 240 Doxorubicin Hydrochloride 2.0mg/ml > 240 Etoposide (Toposar) 20.0mg/ml > 240 Fluorouracil 50.0mg/ml > 240 Paclitaxel (Taxol) 6.0mg/ml > 240 Cisplatin 1.0mg/ml > 240 Dacarbazine (DTIC) 10.0mg/ml > 240 Carmustine (BCNU) 3.3mg/ml 10.7 Thiotepa (THT) 10.0mg/ml 21.5 *Please note that the following 2 drugs have extremely low permeation times: 1. Carmustine: 10.7 minutes 2. Thiotepa: 21.5 minutes Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT). The following chemotherapy drugs have been tested with the black glove: Cyclophosphamide (Cytoxan) 20.0mg/ml > 240 Doxorubicin Hydrochloride 2.0mg/ml > 240 Etoposide (Toposar) 20.0mg/ml > 240 Fluorouracil 50.0mg/ml > 240 Paclitaxel (Taxol) 6.0mg/ml > 240 Cisplatin 1.0mg/ml > 240 Dacarbazine (DTIC) 10.0mg/ml > 240 Carmustine (BCNU) 3.3mg/ml 11.0 Thiotepa (THT) 10.0mg/ml 11.1 *Please note that the following 2 drugs have extremely low permeation times: 1. Carmustine: 11.0 minutes 2. Thiotepa: 11.1 minutes Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).
Device Description
Powder-Free Nitrile Examination Glove (White Colored, Blue Colored, and Black Colored) Tested for Use with Chemotherapy Drugs
More Information

Not Found

Not Found

No
The 510(k) summary describes a physical medical device (examination gloves) and its performance against chemotherapy drugs. There is no mention of software, algorithms, or any technology that would suggest the use of AI or ML.

No
The device is a patient examination glove intended to prevent contamination between patient and examiner, not to treat a condition.

No

The device is a medical glove, a barrier intended to prevent contamination and protect the examiner. It does not gather information about a patient's health or disease state, nor does it provide a diagnosis.

No

The device description clearly states it is a "Powder-Free Nitrile Examination Glove," which is a physical hardware product, not software.

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 procedures.
  • IVD Definition: An In Vitro Diagnostic device is defined as a medical device that is used to perform tests on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Lack of Diagnostic Function: The description of this glove does not involve any testing of patient samples or providing diagnostic information. Its function is purely protective.
  • Chemotherapy Drug Testing: While the glove has been tested for its resistance to chemotherapy drugs, this testing relates to the glove's barrier properties and safety for the user when handling these substances. It does not involve diagnosing or testing the patient.

Therefore, the device described is a medical glove used for barrier protection, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

A powder-free 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.
In addition, the glove was tested for use with chemotherapy drugs in accordance with ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs:

The following chemotherapy drugs have been tested with the white glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minutes
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml11.2
*Thiotepa (THT)10.0mg/ml25.2

*Please note that the following 2 drugs have extremely low permeation times:

    1. Carmustine: 11.2 minutes
    1. Thiotepa: 25.2 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

The following chemotherapy drugs have been tested with the blue glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minute
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml10.7
*Thiotepa (THT)10.0mg/ml21.5

*Please note that the following 2 drugs have extremely low permeation times:

  1. Carmustine: 10.7 minutes
  2. Thiotepa: 21.5 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

The following chemotherapy drugs have been tested with the black glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minutes
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml11.0
*Thiotepa (THT)10.0mg/ml11.1

*Please note that the following 2 drugs have extremely low permeation times:

    1. Carmustine: 11.0 minutes
  1. Thiotepa: 11.1 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

Product codes

LZC, LZA

Device Description

Powder-Free Nitrile Examination Glove (White Colored, Blue Colored, and Black Colored) Tested for Use with Chemotherapy Drugs

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hand

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 glove was tested for use with chemotherapy drugs in accordance with ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.
Results for White Glove:

  • Cyclophosphamide (Cytoxan) 20.0mg/ml: > 240 minutes
  • Doxorubicin Hydrochloride 2.0mg/ml: > 240 minutes
  • Etoposide (Toposar) 20.0mg/ml: > 240 minutes
  • Fluorouracil 50.0mg/ml: > 240 minutes
  • Paclitaxel (Taxol) 6.0mg/ml: > 240 minutes
  • Cisplatin 1.0mg/ml: > 240 minutes
  • Dacarbazine (DTIC) 10.0mg/ml: > 240 minutes
  • Carmustine (BCNU) 3.3mg/ml: 11.2 minutes
  • Thiotepa (THT) 10.0mg/ml: 25.2 minutes

Results for Blue Glove:

  • Cyclophosphamide (Cytoxan) 20.0mg/ml: > 240 minutes
  • Doxorubicin Hydrochloride 2.0mg/ml: > 240 minutes
  • Etoposide (Toposar) 20.0mg/ml: > 240 minutes
  • Fluorouracil 50.0mg/ml: > 240 minutes
  • Paclitaxel (Taxol) 6.0mg/ml: > 240 minutes
  • Cisplatin 1.0mg/ml: > 240 minutes
  • Dacarbazine (DTIC) 10.0mg/ml: > 240 minutes
  • Carmustine (BCNU) 3.3mg/ml: 10.7 minutes
  • Thiotepa (THT) 10.0mg/ml: 21.5 minutes

Results for Black Glove:

  • Cyclophosphamide (Cytoxan) 20.0mg/ml: > 240 minutes
  • Doxorubicin Hydrochloride 2.0mg/ml: > 240 minutes
  • Etoposide (Toposar) 20.0mg/ml: > 240 minutes
  • Fluorouracil 50.0mg/ml: > 240 minutes
  • Paclitaxel (Taxol) 6.0mg/ml: > 240 minutes
  • Cisplatin 1.0mg/ml: > 240 minutes
  • Dacarbazine (DTIC) 10.0mg/ml: > 240 minutes
  • Carmustine (BCNU) 3.3mg/ml: 11.0 minutes
  • Thiotepa (THT) 10.0mg/ml: 11.1 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT) due to very low permeation times.

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.

Not Found

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.

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 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.

October 8, 2020

Encompass Industries Sdn. Bhd. Eunice Yee QA/RA Manager Lot 18256, Kawasan Perindustrian Lot O Kertih Bio-Polymer Park Kemaman, Terengganu 24300 Malaysia

Re: K183562

Trade/Device Name: Powder-Free Nitrile Examination Glove (White Colored, Blue Colored, and Black Colored) Tested for Use with Chemotherapy Drugs Regulation Number: 21 CFR 880.6250 Regulation Name: Non-powdered patient examination glove Regulatory Class: Class I, reserved Product Code: LZC, LZA

Dear Eunice Yee:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated October 23, 2019. FDA is updating your Indication for Use information due to typos in your Indication for Use. Specifically, the permeation times of Carmustine and Thiopeta were written incorrectly.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact OHT4: Office of Surgical and Infection Control Devices, CAPT Elizabeth F. Claverie, MS, Phone Number 301-796-6298, Email Address: Elizabeth.Claverie@fda.hhs.gov.

Sincerely. Elizabeth F. Claverie -S Elizabeth F. Claverie, MS Assistant Director 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

1

Image /page/1/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.

October 23, 2019

Encompass Industries Sdn. Bhd. Eunice Yee QA/RA Manager Lot 18256, Kawasan Perindustrian Lot O Kertih Bio-Polymer Park Kemaman, 24300 My

Re: K183562

Trade/Device Name: Powder-Free Nitrile Examination Glove (White Colored, Blue Colored, and Black Colored) 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: September 19, 2019 Received: September 23, 2019

Dear Eunice Yee:

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.

2

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 medical devices and radiation-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.

Christopher K. Dugard -S

For Elizabeth Claverie, M.S. Assistant Director for THT4B2 Acting Assistant Director for THT4B1 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

3

Indications for Use

510(k) Number (if known) K183562

Device Name

Powder-Free Nitrile Examination Glove (White Colored, and Black Colored) Tested for Use with Chemotherapy Drugs

Indications for Use (Describe)

A powder-free 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.

In addition, the glove was tested for use with chemotherapy drugs in accordance with ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs:

The following chemotherapy drugs have been tested with the white glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minutes
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml11.2
*Thiotepa (THT)10.0mg/ml25.2

*Please note that the following 2 drugs have extremely low permeation times:

    1. Carmustine: 11.2 minutes
    1. Thiotepa: 25.2 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

The following chemotherapy drugs have been tested with the blue glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minute
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml10.7
*Thiotepa (THT)10.0mg/ml21.5

*Please note that the following 2 drugs have extremely low permeation times:

  1. Carmustine: 10.7 minutes

  2. Thiotepa: 21.5 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

4

The following chemotherapy drugs have been tested with the black glove:

Chemotherapy DrugConcentrationBreakthrough Detection Time in Minutes
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
Cisplatin1.0mg/ml> 240
Dacarbazine (DTIC)10.0mg/ml> 240
*Carmustine (BCNU)3.3mg/ml11.0
*Thiotepa (THT)10.0mg/ml11.1

*Please note that the following 2 drugs have extremely low permeation times:

    1. Carmustine: 11.0 minutes
  1. Thiotepa: 11.1 minutes

Warning: Do not use with Carmustine (BCNU) and Thiotepa (THT).

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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