K Number
K210330
Date Cleared
2022-03-04

(393 days)

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

A 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. These gloves were tested for use with chemotherapy drugs and Fentany] Citrate per ASTM D6978-05 (Re-approved 2013) Standard Practice for assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

Device Description

Powder Free Black Nitrile Patient Examination Gloves, Non-Sterile, Tested for Fentanyl Resistance meet all requirements of ASTM D6319, ASTM D6978, and FDA 21 CFR 880.6250. The powder free nitrile examination glove is manufactured from nitrile, a synthetic rubber. Inner surface of gloves undergoes surface treatment process to produce a smooth surface that assists the user in donning the gloves with ease without using any lubricant such as powder on the glove surface. The glove is ambidextrous, i.e. can be worn on right hand or left hand.

AI/ML Overview

This document describes the premarket notification (510(k)) for the Dermagrip Powder Free Black Nitrile Patient Examination Gloves, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistant. The focus of the study is on the non-clinical performance testing of the gloves.

1. Table of Acceptance Criteria and Reported Device Performance

The device performance is compared against several standards, including ASTM D6319, ASTM D6124, ASTM D412, ASTM D3767, ASTM D5151, and ASTM D6978, as well as ISO 10993 for biocompatibility.

CharacteristicStandardAcceptance CriteriaReported Device Performance
Physical PropertiesASTM D412 (Vulcanized Rubber and Thermoplastic Elastomers-Tension)Tensile Strength: Min 14.0 MPa; Ultimate Elongation: Min 400% (After Aging)Tensile Strength: Min 14.0 MPa (Before Aging); 14MPa min (After Aging); Ultimate Elongation: Min 500% (Before Aging); 400% min (After Aging)
DimensionsASTM D3767 (Measurement of Dimensions)Length (all sizes): Min 240 mm; Width (XS: ≤ 80 mm, S: 80 ± 10, M: 95 ± 10, L: 110 ± 10, XL: ≥ 110); Thickness (Finger: Min 0.05 mm, Palm: Min 0.05 mm, Cuff: Min 0.05 mm)All dimensions passed, consistent with the minimum requirements.
Powder FreeASTM D6124 (Residual Powder on Medical Gloves)Less than 2 mg per gloveLess than 2 mg per glove
WatertightASTM D5151 (Detection of Holes in Medical Gloves)Sample size: 500 pcs; Inspection level: G1; AQL: 1.5, Acceptance No. 10Inspection level: G1; AQL: 1.5, Found 2 (within acceptance criteria)
Chemotherapy Drug PermeationASTM D6978-05 (Re-approved 2013) (Assessment of Medical Gloves to Permeation by Chemotherapy Drugs)Minimum breakthrough detection time for various drugsCarmustine (BCNU): 21.2 minutes; Thiotepa: 34.6 minutes; Others (>240 minutes for Cisplatin, Cyclophosphamide, Dacarbazine, Doxorubicin Hydrochloride, Etoposide, Fluorouracil, Ifosfamide, Methotrexate, Mitomycin C, Mitoxantrone, Paclitaxel, Vincristine Sulfate)
Fentanyl ResistanceASTM D6978Breakthrough detection time for Fentanyl Citrate InjectionNo breakthrough up to 240 minutes
Primary Skin IrritationISO 10993-10:2010 (E) & Consumer Product Safety Commission Title 16. Chapter II, Part 1500Non IrritatingPasses (Not a primary skin irritant, PII "0")
Dermal SensitizationISO 10993-10: 2010 (E) & Consumer Product Safety Commission, Title 16, Chapter II, Part 1500.3 (c) (4)Non SensitizationPasses (Not a contact sensitizer)
CytotoxicityISO 10993-5: 2009 (E)Non CytotoxicAcute systemic toxicity testing performed to demonstrate safety (Different from predicate which was Non Cytotoxic).
Acute Systemic ToxicityISO 10993-11:2017 (E)No systemic toxicityConcluded that the product did not induce any systemic toxicity.

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

The document primarily describes non-clinical testing.

  • For the watertight test, the sample size used was 500 pieces.
  • Specific sample sizes for other tests like physical properties, dimensions, residual powder, and biocompatibility are not explicitly stated in quantity, but imply a representative sample was tested to meet the ASTM and ISO standards.
  • The data provenance is from laboratory testing (non-clinical) conducted by the manufacturer, WRP Asia Pacific Sdn Bhd, based in Malaysia. The studies are prospective as they are testing the new device.

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

This information is not applicable as the document describes non-clinical performance testing of medical gloves against established engineering and biological standards, not clinical studies requiring expert interpretation of medical images or patient outcomes. The "ground truth" for these tests is defined by the specific test methods and their measurable endpoints (e.g., breakthrough time, tensile strength values).

4. Adjudication Method for the Test Set

This information is not applicable as the document describes non-clinical performance testing against objective standards, not subjective assessments requiring adjudication by multiple readers.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and Effect Size of AI Improvement

This information is not applicable. The device is a medical glove, not an AI-assisted diagnostic or therapeutic tool. Therefore, an MRMC study or AI-related metrics are irrelevant.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Study Was Done

This information is not applicable. The device is a medical glove, and no algorithm or AI component is involved.

7. The Type of Ground Truth Used

The ground truth used for these studies is based on established industry standards and regulatory requirements, including:

  • ASTM standards (e.g., ASTM D412, D3767, D5151, D6124, D6978) for physical properties, dimensions, watertight integrity, residual powder, and chemical permeation.
  • ISO 10993 standards for biocompatibility (primary skin irritation, dermal sensitization, cytotoxicity, acute systemic toxicity).
    These standards define objective, measurable criteria for the glove's performance.

8. The Sample Size for the Training Set

This information is not applicable. There is no "training set" as this is not a machine learning or AI-based device. Performance is evaluated against pre-defined, physical, and chemical standards.

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

This information is not applicable due to the absence of a training set for this device. The "ground truth" for evaluating the glove's performance is established by the methodologies and specified outcomes mandated by the referenced ASTM and ISO standards.

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Image /page/0/Picture/0 description: The image contains two logos. On the left is the Department of Health & Human Services logo. On the right is the FDA logo, which includes the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

March 4, 2022

WRP Asia Pacific SDN BHD % Saravanan Ramasamy HEAD of QARA Wrp Usa Inc 3700 Massillon Road. Suite 340 Uniontown, Ohio 44685

Re: K210330

Trade/Device Name: Dermagrip Powder Free Black Nitrile Examination Gloves, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistant Regulation Number: 21 CFR 880.6250 Regulation Name: Non-powdered patient examination glove Regulatory Class: Class I, reserved Product Code: LZA, LZC, ODO Dated: February 8, 2022 Received: February 14, 2022

Dear Saravanan Ramasamy:

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.

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

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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,

Clarence W. Murray, III, PhD 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) K210330

Device Name

DERMAGRIP POWDER FREE BLACK NITRILE PATIENT EXAMINATION GLOVE, NON STERILE, TESTED FOR USE WITH CHEMOTHERAPY DRUGS AND FENTANYL RESISTANCE

Indications for Use (Describe)

A 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. These gloves were tested for use with chemotherapy drugs and Fentany] Citrate per ASTM D6978-05 (Re-approved 2013) Standard Practice for assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

Chemotherapy DrugBreakthrough Detection Time in Minutes
*Carmustine (BCNU)21.2
Cisplatin> 240
Cyclophosphamide (Cytoxan)> 240
Dacarbazine> 240
Doxorubicin Hydrochloride> 240
Etoposide> 240
Fluorouracil> 240
Ifosfamide> 240
Methotraxate> 240
Mitomycin C> 240
Mitoxantrone> 240
Paclitaxel> 240
*Thiotepa34.6
Vincristine Sulfate> 240
  • WARNING: Please note the following drugs have extremely low permeation times: Carmustine (BCNU): 21.1 minutes and Thiotepa: 34.6. Do not use with Carmustine and Thiotepa.
Fentanyl ResistanceBreakthrough Detection Time in Minutes
Fentanyl Citrate InjectionNo breakthrough up to 240 minutes

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)
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1.0 Submitter:

Name:Saravanan Ramasamy
Address:WRP Asia Pacific Sdn BhdLot 1, Jalan 3, Kawasan Perusahaan Bandar Baru Salak Tinggi,43900 Sepang, Selangor Darul Ehsan, MALAYSIA
Phone No.:+60 3 8706 1486
Fax No.:+60 3 8706 1485

Date of Summary Prepared: 3 March 2022

2.0 Identification of the subject device:

: Dermagrip Powder Free Black Nitrile Patient Examination Trade Name Glove, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistance Common Name : Patient Examination Gloves Classification Name : Patient Examination Gloves Device Classification : 1 Regulation Number : 21 CFR 880.6250 Product Code

3.0 Predicate Device:

K183287

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

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

Company: Kossan International Sdn. Bhd.

4.0 Description of The Device:

Powder Free Black Nitrile Patient Examination Gloves, Non-Sterile, Tested for Fentanyl Resistance meet all requirements of ASTM D6319, ASTM D6978, and FDA 21 CFR 880.6250.

The powder free nitrile examination glove is manufactured from nitrile, a synthetic rubber. Inner surface of gloves undergoes surface treatment process to produce a smooth surface that assists the user in donning the gloves with ease without using any lubricant such as powder on the glove surface. The glove is ambidextrous, i.e. can be worn on right hand or left hand.

5.0 Indication for use:

Dermagrip Powder Free Black Nitrile Patient Examination Glove, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistance is a disposable device made of synthetic rubber latex intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. The device has also been tested for use with fentanyl citrate.

These gloves were tested for use with Chemotherapy Drugs and Fentanyl Citrate as per ASTM D6978 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs:

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Chemotherapy Drug Permeation

The following chemicals have been tested for the glove.

Chemotherapy DrugConcentrationBreakthrough DetectionTime in Minutes
*Carmustine (BCNU)3.3mg/ml21.2
Cisplatin1.0mg/ml> 240
Cyclophosphamide (Cytoxan)20.0mg/ml> 240
Dacarbazine10.0mg/ml> 240
Doxorubicin Hydrochloride2.0mg/ml> 240
Etoposide (Toposar)20.0mg/ml> 240
Fluorouracil50.0mg/ml> 240
Ifosfamide50.0mg/ml> 240
Mitoxantrone2.0mg/ml> 240
Paclitaxel (Taxol)6.0mg/ml> 240
*Thiotepa10.0mg/ml34.6
Vincristine Sulfate1.0mg/ml> 240
Methotrexate25.0mg/ml> 240
Mitomycin C0.5mg/ml> 240

*WARNING: Please note the following drugs have extremely low permeation times: Carmustine (BCNU): 21.1 minutes and Thiotepa: 34.6. Do not use with Carmustine and Thiotepa.

Fentanyl ResistantConcentrationBreakthrough DetectionTime in Minutes
Fentanyl Citrate Injection100mcg/2mLNo breakthrough up to 240minutes

6.0 Summary of the Technological Characteristics of the Device:

Dermagrip Powder Free Black Nitrile Patient Examination Glove, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistance are summarized with the following technological characteristics compared to ASTM D6319 or equivalent standards as shown in Table 1.

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Table 1
DEVICE PERFORMANCE
CHARACTERISTICSSTANDARDSPREDICATESUBJECT DEVICECOMPARISONANALYSIS
BLUEDERMAGRIP POWDER FREE BLACKNITRILE PATIENT EXAMINATIONGLOVE, NON-STERILE, TESTED FORUSE WITH CHEMOTHERAPY DRUGSAND FENTANYL RESISTANCE
510(k) Number-K183287K210330
Manufacturer(s)-Kossan International Sdn. Bhd.WRP Asia PacificSame
MaterialASTM D6319NitrileNitrileSame
Color-BlueBlackSame
Texture-Fingertips texturedHand textured (Fully texturedsurface from fingertips to end ofpalm )Different
Physical PropertiesASTM D6319MeetsMeets
Before AgingTensile Strength:28Mpa min14MPa minDifferent but
Ultimate Elongation:500% min500% minwithin the ASTMstandard
After AgingTensile Strength:Ultimate Elongation:30Mpa min480% min14MPa min400% minDifferent butwithin the ASTMstandard
Thickness :- Finger- Palm- CuffASTM D63190.10mm0.06mm0.04mm0.05mm min0.05mm min0.05mm minDifferent butwithin the ASTMstandard
Powder FreeASTM D6124Less than 2mg per gloveLess than 2mg per gloveSame
CHARACTERISTICS STANDARDSDEVICE PERFORMANCECOMPARISON ANALYSIS
PREDICATESUBJECT DEVICE
BLUEDERMAGRIP POWDER FREE BLACKNITRILE PATIENT EXAMINATIONGLOVE, NON-STERILE, TESTED FORUSE WITH CHEMOTHERAPY DRUGSAND FENTANYL RESISTANCE
Primary Skin Irritation- ISO 10993-10:2010(E) & ConsumerProduct SafetyCommission Title 16.Chapter II, Part 1500Non IrritatingPasses (Not a primary skinirritant)There was no erythema oroedema noted on test site after(24±2), (48±2) and (72±2)hours. The primary IrritationIndex (PII) was "0"Similar
BiocompatibilityDermal Sensitization-ISO 10993-10: 2010(E) & ConsumerProduct SafetyCommission, Title 16,Chapter II, Part1500.3 (c) (4)Non SensitizationPasses (Not a contactsensitizer).There was no positive allergicreaction observed during thechallenge phase (at 0, 24hours and 48 hours) in animalstreated with the test materialand negative control.Similar
Cytotoxicity - MEMElution, ISO 10993-5:2009 (E)Non CytotoxicAcute systemic toxicity testingperformed to demonstratesafety.Different

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CHARACTERISTICSSTANDARDSDEVICE PERFORMANCECOMPARISONANALYSIS
PREDICATEBLUESUBJECT DEVICE
DERMAGRIP POWDER FREE BLACKNITRILE PATIENT EXAMINATIONGLOVE, NON-STERILE, TESTED FORUSE WITH CHEMOTHERAPY DRUGSAND FENTANYL RESISTANCE
BiocompatibilityAcute SystemicToxicity, ISO 10993-11:2017 (E)Not AvailableIt is concluded that the productdid not induce any systemictoxicity.Different
Watertight (1000ml)ASTM D5151:2019Inspection Level 1, AQL 1.5Inspection Level 1, AQL 1.5Same
Intended use-A patient examination glove is adisposable device intended formedical purposes that is wornon the examiner's hand toprevent contamination betweenpatient and examiner.A patient examination glove isa disposable device intendedfor medical purposes that isworn on the examiner's handor finger to preventcontamination between patientand examiner.Same
SizeMedical GloveGuidance Manual -LabelingX SmallSmallMediumLargeExtra LargeX SmallSmallMediumLargeExtra LargeSame
Single useMedical GloveGuidance Manual -LabelingSingle useSingle useSame

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DEVICE PERFORMANCE
CHARACTERISTICSSTANDARDPREDICATESUBJECT DEVICECOMPARISON ANALYSIS
SBLUEDERMAGRIP POWDER FREE BLACKNITRILE PATIENT EXAMINATIONGLOVE, NON-STERILE, TESTED FORUSE WITH CHEMOTHERAPY DRUGSAND FENTANYL RESISTANCE
Chemotherapy DrugsMinimum BreakthroughMinimum Breakthrough
Permeation TestDetection Time in MinutesDetection Time in Minutes
Carmustine (BCNU) (3.3mg/ml)10.121.1Different
Cisplatin (1.0mg/ml)>240>240Same
Cyclophosphamide (Cytoxan) (20.0mg/ml)>240>240Same
Cytarabine (100.0mg/ml)>240Not AvailableDifferent
Dacarbazine (10.0mg/ml)>240>240Same
Doxorubicin Hydrochloride (2.0mg/ml)>240>240Same
Etoposide (Toposar) (20.0mg/ml)>240>240Same
Fluorouracil (50.0mg/ml)ASTMD6978>240>240Same
Ifosfamide (50.0mg/ml)>240>240Same
Methotrexate (25.0mg/ml)>240>240Same
Mitoxantrone (2.0mg/ml)>240>240Same
Mitomycin C (0.5mg/ml)>240>240Same
Paclitaxel (Taxol) (6.0mg/ml)>240>240Same
*Thiotepa (10.0mg/ml)30.234.6Different
Vincristine Sulfate (1.0mg/ml)>240>240Same
Warning StatementPlease note that Carmustine (BCNU)has extremely low permeation timesof 10.1 minutesWARNING: Please note the followingdrugs have extremely low permeationtimes: Carmustine (BCNU): 21.1 minutesand Thiotepa: 34.6. Do not use withCarmustine and Thiotepa.Different
Fentanyl Resistant (100mcg/2ml)ASTM D6978No breakthrough up to 240 minutesNo breakthrough up to 240 minutesSame

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There are no significant differences between the two products and are identical in terms of intended use, materials design, manufacturing methods except for color, physical properties and thickness.

7.0 Summary of Non-Clinical Testing

The performance test data of the non-clinical test for this powder free nitrile examination glove is summarized as per below.

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TestMethodStandardPurpose of TestingAcceptance CriteriaResults
PhysicalPropertiesASTM D412(Standard TestMethod forVulcanized Rubberand ThermoplasticElastomers-Tension)To evaluate thetensile (tension)properties of glove.TensilestrengthMin 14.0MPaMin 14.0MPaPassPass
UltimateelongationMin500%Min400%PassPass
TestMethodStandardPurpose ofTestingAcceptance CriteriaResults
DimensionASTM D3767Standard Practice forTo measure thelength, width andLength(all sizes)Min 240 mmPass
Rubber-thicknessofWidthXS: ≤ 80 mmPass
Measurement ofgloveS: 80 ± 10Pass
DimensionsM: 95 ± 10Pass
L: 110 ± 10Pass
XL: ≥ 110Pass
Thickness(all sizes)Finger: Min 0.05 mmPass
Palm: Min 0.05 mmPass
Cuff: Min 0.05 mmPass

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TestMethodStandardPurpose ofTestingAcceptance CriteriaResults
WatertightASTM D5151(Standard TestMethod forDetection of Holesin Medical Gloves)To detect holesthat leak waterand therebycompromise theusefulness of theglove.Sample size: 500 pcsInspection level: G1AQL: 1.5, Acceptance No. 10,Found 2Pass
TestMethodStandardPurpose ofTestingAcceptance CriteriaResults
ResidualPowderASTM D6124(Standard TestMethod for ResidualPowder on MedicalGloves)To determine theamount ofresidual powderand non-powdersolids found ongloves.Less than 2 mg per glovePass

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8.0 Summary of Clinical Testing:

No clinical study is included in this submission.

9.0 Conclusion

The conclusion drawn from the non-clinical tests demonstrate that the subject device (Dermagrip Powder Free Black Nitrile Patient Examination Glove, Non-Sterile, Tested for Use with Chemotherapy Drugs and Fentanyl Resistance) is as safe, as effective, and performs as well as or better than the legally marketed predicate devices K183287.

§ 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.