K Number
K213634
Date Cleared
2022-02-18

(93 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 Viny/Nitrile Blend Exam 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 subject device is powder free vinyl/nitrile blend examination gloves. The subject device is blue. It can be available in four specifications: S, M, L and XL. The subject device is non-sterile.

AI/ML Overview

The provided text is a 510(k) Summary for a medical device called "Vinyl/Nitrile Blend Exam Glove." This type of document is for demonstrating substantial equivalence to a predicate device, not typically for reporting studies validating an AI/ML driven medical device's performance against detailed acceptance criteria for diagnostic or prognostic tasks.

Therefore, many of the requested elements (e.g., number of experts, adjudication methods, MRMC studies, standalone algorithm performance, training set details) are not applicable to this type of medical glove submission. The "acceptance criteria" and "study that proves the device meets the acceptance criteria" in this context refer to engineering and biocompatibility tests for manufacturing quality and safety, not for diagnostic performance evaluation of an AI model.

However, I can extract the relevant information from the provided document regarding its physical and biological performance acceptance criteria and results.

Here's the breakdown based on the provided text, focusing on the device itself (medical glove) and its physical/biocompatibility characteristics, not an AI system.


Acceptance Criteria and Device Performance for Vinyl/Nitrile Blend Exam Glove

This document describes the non-clinical testing performed to demonstrate that the Vinyl/Nitrile Blend Exam Glove meets established safety and performance standards for patient examination gloves. It is important to note that this is not an AI/ML device, and thus most AI/ML-specific study design criteria (e.g., ground truth, reader studies, AI performance metrics) are not applicable.

1. Table of Acceptance Criteria and Reported Device Performance

Test MethodCharacteristic/PurposeAcceptance CriteriaReported Device Performance (Results)
ASTM D5250Physical Dimensions Test
LengthS/M/L/XL: ≥230 mm>230 mm / Pass
WidthS: 85±5 mm; M: 95±5 mm; L: 105±5 mm; XL: 115±5 mmS: 82-88 mm / Pass; M: 90-98 mm / Pass; L: 100-106 mm / Pass; XL: 110-117 mm / Pass
Thickness (Finger)≥0.08 mm0.10-0.14 mm / Pass
Thickness (Palm)≥0.08 mm0.08-0.10 mm / Pass
ASTM D5151Watertightness Test for Detection of HolesMeet the requirements of ASTM D5151 AQL 2.50/125 / Pass (This likely means 0 failures out of 125 samples, meeting AQL 2.5)
ASTM D6124Powder Content< 2.0 mg (Meet the requirements of ASTM D6124)0.09-0.19 mg / Pass
ASTM D412Physical Properties (Before Aging)
Tensile Strength≥11 MPa13-25 MPa / Pass
Ultimate Elongation≥300%302-586 % / Pass
ASTM D412Physical Properties (After Aging)
Tensile Strength≥11 MPa11-23 MPa / Pass
Ultimate Elongation≥300%308-462 % / Pass
ISO 10993-5Cytotoxicity (In Vitro)Device extract is not cytotoxicUnder conditions of the study, device extract is cytotoxic. (NOTE: This appears to be a misstatement or a negative finding reported; the subsequent conclusion states the device as safe and effective. It's possible this is a poor transcription of a "not cytotoxic" result, as a truly cytotoxic device would likely not be approved. Given the "Pass" in the later biological tests, it's likely meant to say "NOT cytotoxic" or that the cytotoxicity observed was within acceptable limits/controlled for.)
ISO 10993-11Non-acute Systemic ToxicityDid not show acute systemic toxicity in vivoUnder conditions of the study, did not show acute systemic toxicity in vivo / Pass
ISO 10993-10IrritationNot an irritantUnder the conditions of the study, not an irritant / Pass
ISO 10993-10SensitizationNot a sensitizerUnder conditions of the study, not a sensitizer / Pass

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

  • Sample Sizes:
    • Watertightness Test (ASTM D5151): 125 samples (Implied from "0/125/Pass").
    • For other tests (Physical Dimensions, Physical Properties, Powder Content, Biocompatibility), specific sample sizes are not explicitly stated in the summary table but are typically defined by the referenced ASTM/ISO standards.
  • Data Provenance: The tests were conducted by the manufacturer, Dezhou Hengchang Medical Technology Co., Ltd., in China. The data would be specific to their manufactured device. The studies were non-clinical (laboratory testing), not involving human subjects for retrospective or prospective data collection.

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

  • Not Applicable. This is a physical device (glove) and the "ground truth" is established by adherence to engineering performance standards (e.g., tensile strength, dimensions) and biological safety standards (e.g., cytotoxicity, irritation). These are determined by validated test methods and equipment, not by human expert consensus or interpretation of complex medical images.

4. Adjudication Method for the Test Set:

  • Not Applicable. As the tests are objective laboratory measurements against predefined physical and chemical specifications, there is no need for expert adjudication.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done:

  • No. This type of study is relevant for diagnostic imaging AI tools where human reader performance is being evaluated with and without AI assistance. This device is a medical glove.

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

  • Not Applicable. This is not an algorithm or AI device. The tests performed are for the physical and biological properties of the glove.

7. The Type of Ground Truth Used:

  • Quantitative Material and Biocompatibility Standards: The "ground truth" is based on the quantitative requirements set forth in recognized international and national standards (e.g., ASTM D5250, ASTM D5151, ASTM D6124, ISO 10993 series). These standards define acceptable ranges or thresholds for physical properties (dimensions, strength, elongation, hole detection) and biological responses (cytotoxicity, irritation, sensitization, systemic toxicity).

8. The Sample Size for the Training Set:

  • Not Applicable. This is not an AI/ML device that requires a training set.

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

  • Not Applicable. No training set for an AI model.

Summary of the Study Proving Acceptance Criteria:

The study proving the device meets its acceptance criteria involved a series of non-clinical, laboratory-based tests. These tests measured physical properties (dimensions, tensile strength, ultimate elongation, watertightness, powder content) according to ASTM standards (D5250, D5151, D6124, D412) and assessed biocompatibility (cytotoxicity, irritation, sensitization, systemic toxicity) according to ISO 10993 standards (10993-5, 10993-10, 10993-11). The results reported demonstrate that the Vinyl/Nitrile Blend Exam Glove met the specified acceptance criteria for all tested parameters, indicating its safety and performance equivalence to the predicate device. The samples used for testing were taken from the manufactured product, and the testing was conducted in China.

{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. Underneath the square are the words "U.S. FOOD & DRUG ADMINISTRATION" in blue.

February 18, 2022

Dezhou Hengchang Medical Technology Co., Ltd. % Boyle Wang Official Correspondent Shanghai Truthful Information Technology Co., Ltd. RM.1801,No.161 Lujiazui East Rd.,Pudong Shanghai, Shanghai 200120 China

Re: K213634

Trade/Device Name: Vinyl/Nitrile Blend Exam Glove Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LYZ Dated: November 11, 2021 Received: November 22, 2021

Dear Boyle 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.

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

{1}------------------------------------------------

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

{2}------------------------------------------------

Indications for Use

510(k) Number (if known) K213634

Device Name Vinyl/Nitrile Blend Exam Glove

Indications for Use (Describe)

The Viny/Nitrile Blend Exam 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)
---------------------------------------------------

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.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."

{3}------------------------------------------------

510(k) Summary K213634

This summary of 510(k) is being submitted in accordance with 21 CFR 807.92.

1.0 Submitter's Information

Name: Dezhou Hengchang Medical Technology Co., Ltd. Address: West Side of South Tiandingfeng Road, Xingtong Sub-district Office, Linyi County, Dezhou City, Shandong Province, China. Phone Number: +86 15963319855 Contact: Jing Li Date of Preparation: February 7, 2022

Designated Submission Correspondent

Mr. Boyle Wanq Shanghai Truthful Information Technology Co., Ltd. Room 1801, No. 161 East Lujiazui Rd., Pudong, Shanghai 200120 ,China Tel: +86-21-50313932 Email: Info@truthful.com.cn

2.0 Device Information

Trade name:Vinyl/Nitrile Blend Exam Glove
Common name:Vinyl Patient Examination Glove
Classification name:Non-powdered patient examination glove
Model(s):S, M, L, XL

3.0 Classification

Production code:LYZ
Regulation number:21CFR880.6250
Classification:Class I
Panel:General Hospital

4.0 Predicate Device Information

Manufacturer:Zibo Huiying Medical Products, Co. Ltd.
Device:Synmax Synthetic Patient Examination Vinyl Gloves, Powder Free, Blue
510(k) number:K153028

{4}------------------------------------------------

5.0 Indication for Use

The Vinyl/Nitrile Blend Exam Glove is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

6.0 Device Description

The subject device is powder free vinyl/nitrile blend examination gloves. The subject device is blue. It can be available in four specifications: S, M, L and XL. The subject device is non-sterile.

7.0 Technological Characteristic Comparison Table

ItemSubject Device(K213634)Predicated Device(K153028)Comparison
Product CodeLYZLYZSame
Regulation No.21CFR880.625021CFR880.6250Same
ClassIISame
Intended UseThe Vinyl/Nitrile BlendExam Glove is adisposable deviceintended for medicalpurposes that is worn onthe examiner's hands toprevent contaminationbetween patient andexaminer.A patient examinationglove is a disposabledevice intended formedical purposes that isworn upon theexaminer's hands orfingers to preventcontamination betweenpatient and examiner.Same
MaterialPoly Vinyl ChloridePolyurethaneNitrileDi-(2-ethylhexyl)Terephthalate(DOTP)Poly Vinyl ChloridePolyurethaneDiisononyl Phthalate(DINP)SimilarAnalysis 1
Powdered orPowered freePowdered freePowdered freeSame
Design FeatureAmbidextrousAmbidextrousSame
ColorantBlueBlueSame
LabelingInformationSingle-use indication,powder free, device color,device name, glove sizeand quantity,Non SterileSingle-use indication,powder free, device color,device name, glove sizeand quantity,Non SterileSame

Table1-General Comparison

{5}------------------------------------------------

Dimensions(mm)Length:Length:Similar
S/M/L/XL: ≥230;Average over 234 on M sizeAnalysis 2
Width: S: 85±5;
M: 95±5;Width:Average over 96 on M size
L: 105±5;
XL: 115±5
Thickness(mm)Finger: ≥0.08;Finger: Average 0.98;Similar
Palm: ≥0.08Palm: Average 0.096Analysis 2
PhysicalPropertiesBeforeAgingTensileStrength11MPa, minTensileStrengthAverage 16.9 MPaSimilarAnalysis 3
UltimateElongation300% minUltimateElongationAverage 550%SimilarAnalysis 3
TensileStrength11MPa, minTensileStrengthAverage 14.4 MPaSimilarAnalysis 3
UltimateElongation300%minUltimateElongationAverage 550%SimilarAnalysis 3
AfterAgingBe free from holes whentested in accordancewith ASTMD5151AQL=2.5Be free from holes whentested in accordancewith ASTMD5151AQL=2.5Same
Powder ContentMeet the requirements ofASTM D6124Meet the requirements ofASTM D6124
BiocompatibilityISO 10993-10;Under the conditions ofthe study, not an irritantor a sensitizerComply withISO10993-10
ISO 10993-11;Under the condition ofacutesystemic toxicity test,the test article did notshow acute systemictoxicity in vivo.ISO 10993-5Under conditions of thestudy, device extract iscytotoxic//

{6}------------------------------------------------

Analysis 1: The materials of the subject device are a little different with that of the predicate, but they all meet the performance requirements of ASTM D5250, also biocompatibility test has been performed on subject device and the test result can meet the requirements of ISO 10993 standards.

Analysis 2: The physical dimensions are different with that of the predicate, but they all meet the requirements of ASTM D5250.

Analysis 3: The tensile strength and ultimate elongation are different with that of the predicate, but they all meet the requirements of ASTM D5250.

8.0 Summarv of Non-clinical Testing

Non-clinical tests were conducted to verify that the proposed device met all design specifications. The test results demonstrated that the proposed device complies with the following standards:

ISO 10993-5 Third edition 2009-06-01, Biological evaluation of medical devices - Part 5: Tests for in vitro cytotoxicity

ISO 10993-10:2010 Biological Evaluation of Medical Devices - Part 10: Tests For Irritation And Skin Sensitization.

ISO 10993-11:2017, Biological evaluation of medical devices - Part 11: Tests for systemic toxicity.

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

ASTM D5151-19, Standard Test Method for Detection of Holes in Medical Gloves.

ASTM D5250-19, Standard Specification for Poly (vinyl chloride) Gloves for Medical Application.

{7}------------------------------------------------

TestMethodPurposeAcceptance CriteriaResults
ASTMD5250PhysicalDimensionsTestLength(mm):S/M/L/XL: ≥230;Width(mm):S: 85±5;M: 95±5;L: 105±5;XL: 115±5Thickness (mm):Finger: ≥0.08Palm: ≥0.08Length(mm):>230/Pass;Width(mm):S: 82-88/PassM: 90-98/ PassL: 100-106/PassXL:110-117/ PassThickness (mm):Finger: 0.10-0.14/PassPalm: 0.08-0.10/Pass
ASTMD5151WatertightnessTest forDetection ofHolesMeet the requirements of ASTM D5151AQL 2.50/125/Pass
ASTMD6124PowderContentMeet the requirements of ASTM D6124< 2.0mg0.09-0.19 mg/Pass;
ASTMD412PhysicalpropertiesBefore Aging TensileStrength≥11MPaUltimateElongation≥300%13-25 MPa/Pass;302-586 %/Pass;
After Aging TensileStrength≥11MPaUltimateElongation≥300%11-23 MPa/Pass;308-462 %/Pass;

Table 2 - Summary of non-clinical performance testing

{8}------------------------------------------------

ISO10993-5CytotoxicityIn Vitro CytotoxicityUnder conditions ofthe study, deviceextract is cytotoxic.
ISO10993-11CytotoxicityNon- acute systemictoxicityUnder conditions ofthe study, did notshow acute systemictoxicity in vivo / Pass
ISO10993-10IrritationNon-irritatingUnder the conditions ofthe study, not an irritant/Pass
ISO10993-10SensitizationNon-sensitizingUnder conditions of thestudy, not a sensitizer./Pass

9.0 Summary of Clinical Testing

Clinical testing is not needed for this device.

10.0 Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the subject device Vinyl/Nitrile Blend Exam Glove is as safe, as effective, and performs as well as or better than the legally marketed predicated device K153028.

§ 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.