K Number
K201504
Date Cleared
2021-05-10

(339 days)

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

The Single-use medical poly (vinyl chloride) examination glove is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

Device Description

The proposed device is Powder Free Vinyl Patient Examination Gloves which is made of poly vinyl chloride. The proposed device is clear, non-colored. The design of proposed device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The proposed device is non-sterile.

AI/ML Overview

This document is a 510(k) Pre-Market Notification for a medical device: "Single-use medical poly (vinyl chloride) examination glove." It's primarily a comparison to a predicate device to establish substantial equivalence, not a study proving device meeting acceptance criteria in the context of advanced AI/medical imaging devices. Therefore, many of the requested categories are not applicable.

Here's an analysis based on the provided text, focusing on the available information:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria are generally based on meeting the specifications of various ASTM and ISO standards for medical examination gloves. The reported device performance indicates that the proposed device meets these criteria.

Test ItemAcceptance Criteria (Pass Criteria)Reported Device Performance (Verdict)
Dimension (mm)ASTM D5250Pass
Overall LengthMin 230>230/ Pass
WidthXS: 76±6; S: 85±5; M: 95±5; L: 105±5; XL: 115±5XS: 79-81/ Pass; S: 85-87 /Pass; M: 95-97/ Pass; L: 105-107/ Pass; XL: 115-117/ Pass
Finger thickness0.050.09-0.12/ Pass
Palm thickness0.080.08-0.09/ Pass
Freedom from HolesMeet the requirements of ASTM D5151 AQL 1.50/125, 1/ 125, 4/315, 5/500, 3/200 leaks / Pass (Implies AQL 1.5 met)
Powder ContentMeet the requirements of ASTM D6124 < 2.0mg0.3 – 0.42/ Pass
Physical PropertiesASTM D412Pass
Tensile Strength (MPa)Meet the requirements of ASTM D412 Min 1114-19/ Pass
Ultimate Elongation (%)Meet the requirements of ASTM D412 Min 300%390 – 430/ Pass
Biocompatibility
IrritationNon-irritating (ISO 10993-10)Under the conditions of the study, not an irritant/ Pass
SensitizationNon-sensitizing (ISO 10993-10)Under conditions of the study, not a sensitizer./ Pass
CytotoxicityNon-cytotoxic (ISO 10993-5)Under conditions of the study, did not show potential toxicity to L-929 cells./ Pass

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

  • Sample Size for Test Set: The document provides sample sizes for the "Freedom from Holes" test (e.g., 0/125, 1/125, 4/315, 5/500, 3/200 leaks). These numbers likely refer to the number of failed units out of the total tested for specific batches or sample groups to demonstrate compliance with AQL (Acceptable Quality Level) 1.5. For other tests like Dimensions, Powder Content, Physical Properties, and Biocompatibility, specific sample numbers are not explicitly stated, but are implied to be sufficient for compliance with the stated ASTM and ISO standards.
  • Data Provenance: The document does not specify the country of origin of the data. Given the applicant is Anhui Bytech Medical Supplies Co., Ltd. in China and the submission correspondent is Shanghai SUNGO Management Consulting Co., Ltd. also in China, it's highly probable the testing was conducted in China. The data is based on non-clinical performance testing, effectively a prospective quality control assessment of manufactured gloves against established standards.

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

  • This section is not applicable to this type of device submission. The "ground truth" for these tests are objective measurements against established technical standards (ASTM, ISO), not expert consensus on medical interpretation.

4. Adjudication Method for the Test Set

  • This section is not applicable. The tests performed are objective measurements against defined criteria in standards, not subjective assessments requiring 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 diagnostic imaging devices where human readers interpret results with and without AI assistance. This document describes a physical medical device (examination glove).

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

  • Not applicable. This is not an AI algorithm. The device is a physical glove. Performance is measured directly from the physical characteristics of the glove.

7. The Type of Ground Truth Used

  • The "ground truth" for the non-clinical performance and biocompatibility tests are the specifications and acceptable limits defined within the referenced international standards (ASTM D5250, ASTM D5151, ASTM D6124, ASTM D412, ISO 10993-10, ISO 10993-5). This is an objective, standardized basis for evaluation.

8. The Sample Size for the Training Set

  • This concept is not applicable here. There is no "training set" in the context of an AI/machine learning model. The device's manufacturing process is designed to produce gloves meeting specifications, not "trained" on data.

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

  • Not applicable, as there is no training set for this device.

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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 a blue square with the letters "FDA" in white, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue.

May 10, 2021

Anhui Bytech Medical Supplies Co., Ltd. % Ivy Wang Technical Manager Shanghai SUNGO Management Consultanting Co., Ltd. 13th F, 1500# Century Avenue Shanghai, Shanghai 200122 China

Re: K201504

Trade/Device Name: Single-use medical poly (vinyl chloride) examination glove Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LYZ Dated: June 5, 2020 Received: June 5, 2020

Dear Ivy Wang:

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.

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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 and Part medical device reporting (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.

For Clarence W. Murray III, Ph.D. Acting 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

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Indications for Use

510(k) Number (if known) K201504

Device Name

Single-use medical poly (vinyl chloride) examination glove

Indications for Use (Describe)

The Single-use medical poly (vinyl chloride) examination glove is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

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

K201504 Date of preparation: 05 -10-2021

A. Applicant

Name: ANHUI BYTECH MEDICAL SUPPLIES CO., LTD. Address: LingBi Economic Development Zone (North), SuZhou City, Anhui Provice Name: Mr. Cheng Wang Tel: +86-0557-6602888 Fax: +86-0557-6602888

Submission Correspondent: Primary contact: Ms. Ivy Wang Shanghai SUNGO Management Consulting Co., Ltd. Room 1401, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: +86-21-58817802 Email: haiyu.wang@sungoglobal.com Secondary contact: Mr. Raymond Luo Room 1401, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: +86-21-68828050 Email: fda.sungo@@gmail.com

B. Device

Trade Name: Single-use medical poly (vinyl chloride) examination glove Common Name: Vinyl Patient Examination Gloves (Powder Free) Model(s): XS, S, M, L, XL

Regulatory Information Classification Name: Vinyl Patient Examination Gloves (Powder Free) Classification: Class I. Product code: LYZ Regulation Number: 21 CFR 880.6250 Review Panel: General Hospital

C. Predicate device

SponsorHUIFU TRADING CO., LTD.
Device NameVinyl Examination Glove (Clear, Non-Colored)

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510(k) NumberK180849
Product CodeLYZ
Regulation Number880.6250
Regulation ClassI

D. Indications for use of the device:

The Single-use medical poly (vinyl chloride) examination glove is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

E. Device Description:

The proposed device is Powder Free Vinyl Patient Examination Gloves which is made of poly vinyl chloride. The proposed device is clear, non-colored. The design of proposed device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The proposed device is non-sterile.

F. Comparison with predicate device

Table 1 General Comparison

ITEMProposed Device(K201504)Predicate Device (K180849)Remark
Product CodeLYZLYZSAME
Regulation No.21 CFR 880.625021 CFR 880.6250SAME
ClassIISAME
Intended UseThe Single-use medical poly(vinyl chloride) examinationglove is a disposable deviceintended for medical purposesthat is worn on the examiner'shands to prevent contaminationbetween patient and examiner.The Vinyl Patient ExaminationGlove(Clear, Non-Colored) is adisposable device intended formedical purposes that is worn on theexaminer's hands to preventcontamination between patient andexaminer.SAME
Powdered orPowered freePowdered freePowdered freeSAME
Design FeatureambidextrousambidextrousSAME
Surface FeatureSmoothSmoothSAME
Device MaterialsVinylVinylSAME
ColorClearClearSAME

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LabelingInformationSingle-use indication, powder free, device color, device name glove size and quantity, Vinyl Examination Gloves, Non-SterileSingle-use indication, powder free, device color, device name, glove size and quantity, Vinyl Examination Gloves, Non-SterileSAME
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Table 2 Device Dimensions Comparison

ITEMProposed Device (K201504)Predicate Device (K180849)Remark
SizeXSSMLXLSMLXLsimilar
Length, mmMinimum 230Minimum230Minimum235Minimum245Minimum245similar
Width, mm78±385±395±3105±3115±385±595±5105±5115±5similar
Thickness, mmFinger: minimum 0.05Finger: minimum 0.08Differer
Palm: minimum 0.08Palm: minimum 0.08Same

Discussion: The proposed device has slight difference on the dimensions of Length, width and finger thickness to the predicate device. However, the testing results meet the specification as stated in ASTM D5250. This difference will not affect the safety and effectiveness of the proposed device.

Table 3 Performance Comparison

ITEMProposed Device(K201504)Predicate Device(K180849)Remark
ColorantClear, Non-ColoredClear, Non-ColoredSame
PhysicalPropertiesBefore AgingSimilar
Tensile Strength11 MPa, min
Ultimate Elongation300 % min
After AgingTensile StrengthUltimate Elongation11 MPa, min300 % min
Freedom from HolesBe free from holes when tested in accordance with ASTM D5151 AQL = 1.5Be free from holes when tested in accordance with ASTM D5151 AQL =1.5Same

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Powder ContentMeets Applicable Definition forPowder Free: ≤ 2 mg per glove0.5 mgSimilar
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Discussion: The proposed device has slight difference on the performance of physical properties and powder content to the predicate device. However, the testing results meet the specification as stated in ASTM D5250 and ASTM D6124. This difference will not affectiveness of the proposed device. The proposed device use the same AQL=1.5 as the predicate device, which is the requirement for European market and also meet the specification as stated in ASTM D5151. This will not affect the safety and effectiveness of the proposed device.

Table 4 Safety Comparison

ITEMPredicate Device (K180849)Proposed Device (K201504)Remark
BiocompatibilityIrritationComply with ISO 10993-10Under the conditions of the study not an irritant
SensitizationUnder conditions of the study, not a sensitizer.
CytotoxicityComply with ISO 10993-5Under conditions of the study, did not show potential toxicity to L-929 cells.
Label and LabelingMeet FDA's RequirementsMeet FDA's RequirementsSame

G. Summary of non-clinical performance testing

Test itemTest methodPass criteriaTest results/ Verdict
Dimension(mm)Overall LengthASTM D5250Min 230>230/ Pass
WidthXS: 76±6S: 85±5M: 95±5L: 105±5XL: 115±5XS: 79-81/ PassS: 85-87 /PassM: 95-97/ PassL: 105-107/ PassXL: 115-117/ Pass
Finger thickness0.050.09-0.12/ Pass
Palm thickness0.080.08-0.09/ Pass
Freedom from HolesASTM D5151Meet therequirements of ASTMD5151 AQL 1.50/125, 1/ 125, 4/315,5/500, 3/200 leaks /Pass
Powder ContentASTM D6124Meet the requirements ofASTM D6124 < 2.0mg0.3 – 0.42/ Pass
PhysicalpropertiesTensile Strength(MPa)ASTM D412Meet the requirementsof ASTM D412 Min 1114-19/ Pass
UltimateElongation (%)Meet the requirements ofASTM D412 Min 300%390 – 430/ Pass
BiocompatibilityIrritationISO 10993-10Non-irritatingUnder the conditions of

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the study, not an irritant/ Pass
SensitizationISO 10993-10Non-sensitizingUnder conditions of the study, not a sensitizer./ Pass
CytotoxicityISO 10993-5Non-cytotoxicUnder conditions of the study, did not show potential toxicity to L-929 cells./ Pass

Biocompatibility testing:

  • Skin sensitization & Irritation -- ISO 10993-10:2010 Biological Evaluation of Medical Devices Part A 10: Tests For Irritation And Skin Sensitization.
  • A Cytotoxicity -- ISO 10993-5:2009 Biological Evaluation of Medical Devices - Part 5: Tests For In Vitro Cytotoxicity

Performance testing:

  • Residue Powder -- ASTM D6124-06 (Reaffirmation 2017), Standard Test Method for Residual Powder on Medical Gloves

  • A Freedom from holes -- ASTM D5151-06 (Reapproved 2015), Standard Test Method for Detection of Holes in Medical Gloves.
  • Physical properties & Dimensions -- ASTM D5250-06 (Reapproved 2015), Standard Specification for Poly (vinyl chloride) Gloves for Medical Application.

  • A ISO 2859-1:1999, "Sampling Procedures for Inspection by Attributes - Part I: Sampling Plans Indexed by Acceptable Quality Level (AQL) for Lot-by-LotInspection.

H. Summary of Clinical Performance Test

No clinical study is included in this submission.

l. Conclusion

The conclusion drawn from the nonclinical tests demonstrates that the subject device in 510(K) submission K201504, the Single-use medical poly (vinyl chloride) examination glove is as safe, as effective, and performs as well as or better than the legally marketed predicate device cleared under K180849.

§ 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.