K Number
K200453
Device Name
NON-STERILE, POWDER FREE NITRILE EXAMINATION GLOVES, LOW DERMATITIS POTENTIAL, AND TESTED FOR USE WITH CHEMOTHERAPY DRUGS BLUE-AC
Date Cleared
2020-05-01

(67 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 purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs: | Blue | | |--------------------------------------------|-----------------------------------------------| | Tested Chemotherapy Drug And Concentration | Average Breakthrough Detection Time (minutes) | | Carboplatin, 10 mg/ml | > 240 minutes | | Carmustine, 3.3 mg/ml | 11.3 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 | 7.4 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): 11.3 minutes ThioTEPA (10.0 mg/ml): 7.4 minutes WARNING: NOT TO BE USED WITH CARMUSTINE OR THIOTEPA A patient examination glove 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. In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and Fentanyl Citrate: | Blue | | |--------------------------------------------|-----------------------------------------------| | Tested Chemotherapy Drug And Concentration | Average Breakthrough Detection Time (minutes) | | Carboplatin, 10 mg/ml | > 240 minutes | | Carmustine, 3.3 mg/ml | 30.3 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 | 91.0 minutes | | Vincristine Sulfate, 1.0 mg/ml | > 240 minutes | | Busulfan, 6 mg/ml | > 240 minutes | | Cytarabine, 100 mg/ml | > 240 minutes | | Daunorubicin, 5 mg/ml | > 240 minutes | | Docetaxel, 10 mg/ml | > 240 minutes | | Epirubicin, 2 mg/ml | > 240 minutes | | Gemcitabine, 38 mg/ml | > 240 minutes | | Irinotecan Hydrochloride, 20 mg/ml | > 240 minutes | | Mechlorethamine HCL, 1.0 mg/ml | > 240 minutes | | Melphalan, 5 mg/ml | > 240 minutes | | Trisenox, 0.1 mg/ml | > 240 minutes | | Fentanyl Citrate, 100mcg/2ml | > 240 minutes | The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 30.3 minutes ThioTEPA (10.0 mg/ml): 91.0 minutes CAUTION: CARMUSTINE (3.3 MG/ML) AND THIOTEPA (10 MG/ML) HAVE MUCH LOWER PERMEATION TIMES COMPARE TO OTHER CHEMOTHERAPY DRUGS
Device Description
Non-Sterile, Powder Free Nitrile Examination Gloves, Low Dermatitis Potential, And Tested for use with Chemotherapy Drugs Blue; Non-Sterile, Powder Free Nitrile Examination Gloves, Tested for use with Chemotherapy Drugs and Fentanyl Citrate - Blue
More Information

Not Found

Not Found

No
The 510(k) summary describes a physical medical device (examination gloves) and its performance against chemical permeation. There is no mention of software, algorithms, data processing, or any other components 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, and offers resistance to permeation by chemotherapy drugs and fentanyl citrate. It does not treat or cure any medical condition.

No

The device is a patient examination glove, intended to prevent contamination between patient and examiner and offer protection against certain chemotherapy drugs. It does not perform any diagnostic function.

No

The device described is a physical medical device (examination gloves) and does not involve any software component.

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

Here's why:

  • Intended Use: The stated intended use 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 describes a barrier device used for protection during physical examination or handling.
  • IVD Definition: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, or tissue) to provide information about a person's health. This device does not perform any such tests.
  • Chemotherapy Drug Testing: While the gloves are tested for resistance to chemotherapy drugs, this testing is related to the performance and safety of the glove as a barrier, not to diagnose, monitor, or treat a patient based on a sample.

The information about chemotherapy drug permeation is a performance characteristic of the glove, indicating its suitability for use in environments where these drugs are present, but it doesn't change the fundamental nature of the device from a barrier to an IVD.

N/A

Intended Use / Indications for Use
A patient examination glove 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. In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs: The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 11.3 minutes ThioTEPA (10.0 mg/ml): 7.4 minutes WARNING: NOT TO BE USED WITH CARMUSTINE OR THIOTEPA
A patient examination glove 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. In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and Fentanyl Citrate: The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 30.3 minutes ThioTEPA (10.0 mg/ml): 91.0 minutes CAUTION: CARMUSTINE (3.3 MG/ML) AND THIOTEPA (10 MG/ML) HAVE MUCH LOWER PERMEATION TIMES COMPARE TO OTHER CHEMOTHERAPY DRUGS

Product codes (comma separated list FDA assigned to the subject device)
LZA, LZC, QDO

Device Description
Not Found

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)
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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.
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 shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" followed by the words "U.S. Food & Drug Administration" in a larger font and the word "Administration" in a smaller font.

May 1, 2020

YTY Industry (Manjung) Sdn Bhd Punitha Samy Senior Manager (YTY Group DCRA & YTY Industry QA) Lot 1422-1424, Batu 10 Lekir Sitiawan, Perak 32020 Malaysia

Re: K200453

Trade/Device Name: Non-Sterile, Powder Free Nitrile Examination Gloves, Low Dermatitis Potential, And Tested for use with Chemotherapy Drugs Blue; Non-Sterile, Powder Free Nitrile Examination Gloves, Tested for use with Chemotherapy Drugs and Fentanyl Citrate - Blue Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved

Dated: February 17, 2020

Product Code: LZA, LZC, QDO

Received: February 24, 2020

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. 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 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,

CAPT Elizabeth Claverie, M.S. 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

Enclosure

2

Indications for Use

510(k) Number (if known) K200453

Device Name

Non-Sterile, Powder Free Nitrile Examination Gloves, Low Dermatitis Potential, And Tested for use with Chemotherapy Drugs Blue

Indications for Use (Describe)

A patient examination glove 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.

In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs:

Blue
Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time (minutes)
Carboplatin, 10 mg/ml> 240 minutes
Carmustine, 3.3 mg/ml11.3 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/ml7.4 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): 11.3 minutes ThioTEPA (10.0 mg/ml): 7.4 minutes

WARNING: NOT TO BE USED WITH CARMUSTINE OR 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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

3

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."

4

Indications for Use

510(k) Number (if known) K200453

Device Name

Non-Sterile, Powder Free Nitrile Examination Gloves, Tested for use with Chemotherapy Drugs and Fentanyl Cirate - Blue

Indications for Use (Describe)

A patient examination glove 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.

In addition, these gloves were tested for use with chemotherapy drugs in accordance with ASTM D6978 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs and Fentanyl Citrate:

Blue
Tested Chemotherapy Drug And ConcentrationAverage Breakthrough Detection Time (minutes)
Carboplatin, 10 mg/ml> 240 minutes
Carmustine, 3.3 mg/ml30.3 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/ml91.0 minutes
Vincristine Sulfate, 1.0 mg/ml> 240 minutes
Busulfan, 6 mg/ml> 240 minutes
Cytarabine, 100 mg/ml> 240 minutes
Daunorubicin, 5 mg/ml> 240 minutes
Docetaxel, 10 mg/ml> 240 minutes
Epirubicin, 2 mg/ml> 240 minutes
Gemcitabine, 38 mg/ml> 240 minutes
Irinotecan Hydrochloride, 20 mg/ml> 240 minutes
Mechlorethamine HCL, 1.0 mg/ml> 240 minutes
Melphalan, 5 mg/ml> 240 minutes
Trisenox, 0.1 mg/ml> 240 minutes
Fentanyl Citrate, 100mcg/2ml> 240 minutes

The following chemotherapy drugs and concentration have extremely low permeation time. Carmustine (3.3 mg/ml): 30.3 minutes ThioTEPA (10.0 mg/ml): 91.0 minutes

CAUTION: CARMUSTINE (3.3 MG/ML) AND THIOTEPA (10 MG/ML) HAVE MUCH LOWER PERMEATION TIMES COMPARE TO OTHER CHEMOTHERAPY DRUGS

5

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.

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.qov

"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."