K Number
K250313
Date Cleared
2025-08-19

(197 days)

Product Code
Regulation Number
878.4460
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

The tested drugs are:

CompoundMinimum Breakthrough Time (minutes)
Carmustine (BCNU) (3.3 mg/ml)15.8
Cyclophosphamide (20 mg/ml)>240
Doxorubicin (2 mg/ml)>240
Etoposide (Toposar) (20 mg/ml)>240
Fluorouracil (50 mg/ml)>240
Paclitaxel (6 mg/ml)>240
Thiotepa (THT) (10 mg/ml)24.6
Bleomycin sulfate (15 mg/ml)>240
Carboplatin (10 mg/ml)>240
Cisplatin (1 mg/ml)>240
Cytarabine (100 mg/ml)>240
Dacarbazine (10 mg/ml)>240
Daunorubicin HCl (5 mg/ml)>240
Docetaxel (10 mg/ml)>240
Gemcitabine HCl (38 mg/ml)>240
Idarubicin HCl (1 mg/ml)>240
Ifosfamide (50 mg/ml)>240
Irinotecan HCl (20 mg/ml)>240
Mechlorethamine HCl (1 mg/ml)>240
Melphalan HCl (5 mg/ml)>240
Methotrexate (25 mg/ml)>240
Mitomycin C (0.5 mg/ml)>240
Mitoxantrone (2 mg/ml)>240
Vincristine Sulfate (1 mg/ml)>240
Busulfan (6 mg/ml)>240
Chloroquine (50 mg/ml)>240
Cyclosporin A (100 mg/ml)>240
Epirubicin HCl (2 mg/ml)>240
Fludarabine Phosphate (25 mg/ml)>240
Oxaliplatin (2 mg/ml)>240
Retrovir (10 mg/ml)>240
Rituximab (10 mg/ml)>240
Topotecan HCl (1 mg/ml)>240
Trisenox (Arsenic Trioxide) (1 mg/ml)>240
Velcade (Bortezomib) (1 mg/ml)>240

Simulated Gastric Acid Fluid was also tested with a minimum breakthrough greater than 240 minutes.

Device Description

Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is a sterile and disposable device. This glove is made of synthetic polyisoprene rubber inside coated with synthetic material to ease donning the glove. The device is intended to be worn on hands, usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. These gloves were tested for use with Chemotherapy Drugs and Gastric Acid as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

The device conforms to the following FDA recognized consensus standards: ASTM D3577-19, ASTM D6124-06, ASTM D5151-19, ASTM D412-16, ISO 11137-1:2006 + AMD1:2013 + AMD2:2018, ISO 11137-2:2013 + AMD1:2022, and ASTM D6978-05.

Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is available in the following sizes: 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, and 9.0.

AI/ML Overview

The provided document is a 510(k) clearance letter from the FDA for a medical device: "Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid." This document outlines the general requirements for the device and details the non-clinical testing performed to establish substantial equivalence to a predicate device.

However, it does not contain any information regarding clinical studies, AI/ML device performance, or human-in-the-loop studies. The device is a physical medical glove and not an AI-powered diagnostic or assistive tool. Therefore, the requested information elements related to AI/ML and clinical study methodologies are not applicable to this submission.

The document focuses on demonstrating the physical, chemical, and biological safety and performance of the gloves according to recognized consensus standards.

Here's the relevant information that can be extracted:

1. Table of Acceptance Criteria and Reported Device Performance

The device underwent non-clinical testing against several recognized standards. The "Results" column consistently states "PASS," indicating that the device met the specified acceptance criteria for each test.

Title of TestPurpose of TestAcceptance CriteriaReported Device Performance
ASTM D3577-19DimensionsMeets criteria in accordance with ASTM D3577-19: Standard Specification for Rubber Surgical GlovesPASS
ASTM D3577-19Physical PropertiesMeets criteria for tensile strength, ultimate elongation and stress at 500% elongation before and after accelerated aging for synthetic surgical gloves per ASTM D3577-19: Standard Specification for Rubber Surgical GlovesPASS
ASTM D5151-19Freedom from holesMeets criteria in accordance with ASTM D3577-19: Standard Specification for Rubber Surgical Gloves with AQL requirements of 0.65PASS
ASTM D6124Powder-FreeMeets applicable acceptance criteria for powder free ≤ 2mg per glove per ASTM D3577-19: Standard Specification for Rubber Surgical GlovesPASS
ISO 11137-1:2006SterilityMeets acceptance criteria requirement of 10⁻⁶ SAL per ISO 11137-1: Sterilization for health care products – Radiation – Part 1: Requirements for development, validation and routine control of a sterilization process for medical devicesPASS
ASTM D6978-05Chemotherapy Drug Permeation TestTesting performed in accordance with ASTM D6978-05: Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs.PASS
ISO 10993-10:2010Biocompatibility: Skin IrritationPasses Primary Skin Irritation test per ISO 10993-10, Biological Evaluation of medical devices, Part 10: Test for irritation and skin sensitization. Under the conditions of the study, not an irritant.PASS
ISO 10993-10:2010Biocompatibility: Dermal SensitizationPasses Dermal Sensitization test per ISO 10993-10, Biological Evaluation of medical devices, Part 10: Test for irritation and skin sensitization. Under the conditions of the study, not a sensitizer.PASS
ISO 10993-11:2017Biocompatibility: Acute Systemic ToxicityPasses Acute Systemic Toxicity Test per ISO 10993-11, Biological Evaluation of medical devices, Part 11: Test for systemic toxicity. Under the conditions of the study, there was no mortality or evidence of acute systemic toxicity.PASS
ISO 10993-11:2017Biocompatibility: Material-Mediated PyrogenicityPasses Material-Mediated Pyrogenicity Test per ISO 10993-11, Biological Evaluation of medical devices, Part 11: Test for systemic toxicity. Under the conditions of the study, no pyrogenic response was observed.PASS
USP <85>Endotoxin TestingMeets acceptance criteria for bacterial endotoxins per USP <85> Bacterial Endotoxins Test. Endotoxin level ≤ 20 EU/device.PASS

Chemotherapy Drug Permeation Results:

CompoundMinimum Breakthrough Time (minutes)
Carmustine (BCNU) (3.3 mg/ml)15.8
Cyclophosphamide (20 mg/ml)>240
Doxorubicin (2 mg/ml)>240
Etoposide (Toposar) (20 mg/ml)>240
Fluorouracil (50 mg/ml)>240
Paclitaxel (6 mg/ml)>240
Thiotepa (THT) (10 mg/ml)24.6
Bleomycin sulfate (15 mg/ml)>240
Carboplatin (10 mg/ml)>240
Cisplatin (1 mg/ml)>240
Cytarabine (100 mg/ml)>240
Dacarbazine (10 mg/ml)>240
Daunorubicin HCl (5 mg/ml)>240
Docetaxel (10 mg/ml)>240
Gemcitabine HCl (38 mg/ml)>240
Idarubicin HCl (1 mg/ml)>240
Ifosfamide (50 mg/ml)>240
Irinotecan HCl (20 mg/ml)>240
Mechlorethamine HCl (1 mg/ml)>240
Melphalan HCl (5 mg/ml)>240
Methotrexate (25 mg/ml)>240
Mitomycin C (0.5 mg/ml)>240
Mitoxantrone (2 mg/ml)>240
Vincristine Sulfate (1 mg/ml)>240
Busulfan (6 mg/ml)>240
Chloroquine (50 mg/ml)>240
Cyclosporin A (100 mg/ml)>240
Epirubicin HCl (2 mg/ml)>240
Fludarabine Phosphate (25 mg/ml)>240
Oxaliplatin (2 mg/ml)>240
Retrovir (10 mg/ml)>240
Rituximab (10 mg/ml)>240
Topotecan HCl (1 mg/ml)>240
Trisenox (Arsenic Trioxide) (1 mg/ml)>240
Velcade (Bortezomib) (1 mg/ml)>240
Stomach Acid>240

Warning: Carmustine: 15.8 minutes and Thiotepa: 24.6 minutes. Do not use with Carmustine and Thiotepa.

Summary of Study Information (Not Applicable for this Device Type)

The provided document describes a Class I medical device (Sterile Powder Free Synthetic Rubber Surgeon's Gloves) which is a physical product, not a software device or an AI/ML-driven system. Therefore, the following requested information points related to AI/ML device performance and clinical study methodologies are not applicable. The submission primarily relied on non-clinical (bench) testing to demonstrate substantial equivalence to a predicate device.

  1. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective): Not applicable, as this is a physical device tested via non-clinical laboratory methods according to recognized standards (e.g., ASTM, ISO). The specific sample sizes for each non-clinical test (e.g., number of gloves for tensile strength, number of samples for permeation, number of animals for biocompatibility) are part of the detailed test reports but are not summarized in this FDA summary document. Data provenance details like country of origin for test materials or retrospective/prospective nature are not specified as they are not relevant for this type of non-clinical testing.
  2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience): Not applicable. "Ground truth" in the context of expert consensus is typically relevant for diagnostic AI/ML devices interpreting medical images or other complex data. For gloves, "ground truth" is established by adherence to quantitative physical, chemical, and biological performance standards.
  3. Adjudication method (e.g. 2+1, 3+1, none) for the test set: Not applicable. Adjudication methods are used in clinical trials or expert review panels, not for standard physical/chemical testing of a device like a glove.
  4. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This device is not an AI system nor does it involve human readers.
  5. If a standalone (i.e. algorithm only without human-in-the loop performance) was done: Not applicable. This device is not an algorithm.
  6. The type of ground truth used (expert consensus, pathology, outcomes data, etc.): For this device, the "ground truth" is adherence to the specified performance criteria defined by the listed consensus standards (e.g., ASTM D3577 for physical properties, ASTM D6978 for chemotherapy permeation, ISO 10993 for biocompatibility). These standards define acceptable quantitative limits or qualitative responses (e.g., "not an irritant").
  7. The sample size for the training set: Not applicable. This device does not involve a "training set" as it is not an AI/ML device.
  8. How the ground truth for the training set was established: Not applicable. This device does not involve a "training set."

Conclusion:

The FDA document K250313 confirms the clearance of sterile surgeon's gloves based on their adherence to established non-clinical performance and safety standards, including physical properties, sterility, and resistance to chemotherapy drugs and gastric acid. The document explicitly states that "[a] clinical study was not conducted in support of this submission." The questions related to AI/ML, clinical study designs, expert ground truth, and training data are not relevant to this specific device submission.

FDA 510(k) Clearance Letter - K250313

Page 1

U.S. Food & Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
www.fda.gov

Doc ID # 04017.08.00

August 19, 2025

HARPS Europe Manufacturing GmbH
℅ Jay Mansour
Regulatory consultant / Principal
Mansour Consulting LLC
845 Aronson Lake Court
Roswell, Georgia 30075

Re: K250313
Trade/Device Name: Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
Regulation Number: 21 CFR 878.4460
Regulation Name: Non-Powdered Surgeon's Glove
Regulatory Class: Class I, reserved
Product Code: KGO, LZC
Dated: February 3, 2025
Received: July 21, 2025

Dear Jay Mansour:

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 (the 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 available 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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K250313 - Jay Mansour Page 2

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 (reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reporting-combination-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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-devices/device-advice-comprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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-devices/medical-device-safety/medical-device-reporting-mdr-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/medical-devices/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-devices/device-advice-comprehensive-regulatory-

Page 3

K250313 - Jay Mansour Page 3

assistance/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,

ALLAN GUAN -S

For Bifeng Qian, M.D., Ph.D.
Assistant Director
DHT4C: Division of Infection Control Devices
OHT4: Office of Surgical and Infection Control Devices
Office of Product Evaluation and Quality
Center for Devices and Radiological Health

Enclosure

Page 4

FORM FDA 3881 (8/23) Page 1 of 2

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Indications for Use

Form Approved: OMB No. 0910-0120
Expiration Date: 07/31/2026

510(k) Number (if known): K250313

Device Name: Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid

Indications for Use (Describe)

The Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

The tested drugs are:

CompoundMinimum Breakthrough Time (minutes)
Carmustine (BCNU) (3.3 mg/ml)15.8
Cyclophosphamide (20 mg/ml)>240
Doxorubicin (2 mg/ml)>240
Etoposide (Toposar) (20 mg/ml)>240
Fluorouracil (50 mg/ml)>240
Paclitaxel (6 mg/ml)>240
Thiotepa (THT) (10 mg/ml)24.6
Bleomycin sulfate (15 mg/ml)>240
Carboplatin (10 mg/ml)>240
Cisplatin (1 mg/ml)>240
Cytarabine (100 mg/ml)>240
Dacarbazine (10 mg/ml)>240
Daunorubicin HCl (5 mg/ml)>240
Docetaxel (10 mg/ml)>240
Gemcitabine HCl (38 mg/ml)>240
Idarubicin HCl (1 mg/ml)>240
Ifosfamide (50 mg/ml)>240
Irinotecan HCl (20 mg/ml)>240
Mechlorethamine HCl (1 mg/ml)>240
Melphalan HCl (5 mg/ml)>240
Methotrexate (25 mg/ml)>240
Mitomycin C (0.5 mg/ml)>240
Mitoxantrone (2 mg/ml)>240
Vincristine Sulfate (1 mg/ml)>240
Busulfan (6 mg/ml)>240
Chloroquine (50 mg/ml)>240
Cyclosporin A (100 mg/ml)>240
Epirubicin HCl (2 mg/ml)>240
Fludarabine Phosphate (25 mg/ml)>240
Oxaliplatin (2 mg/ml)>240
Retrovir (10 mg/ml)>240
Rituximab (10 mg/ml)>240
Topotecan HCl (1 mg/ml)>240
Trisenox (Arsenic Trioxide) (1 mg/ml)>240
Velcade (Bortezomib) (1 mg/ml)>240

Simulated Gastric Acid Fluid was also tested with a minimum breakthrough greater than 240 minutes.

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FORM FDA 3881 (8/23) Page 2 of 2

WARNING:
Please note the following drugs have extremely low permeation times:
Carmustine: 15.8 minutes and Thiotepa: 24.6 minutes. Do not use with Carmustine and Thiotepa.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

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Page 6

510K Summary

HARPS Europe Manufacturing GmbH K250313
Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
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510(k) Number: K250313

Submitter: HARPS Europe Manufacturing GmbH
TRIESTER BUNDESSTRASSE 26
WIMPASSING NIEDEROSTERREICH
Niederosterreich 2632
Austria

Contact Person(s): Dr. Alexander Weinert
Phone: +43676850868240
Email: alexander.weinert@harpsglobal.com

Correspondent: Mansour Consulting LLC
845 Aronson Lake Court
Roswell GA 30075
United States
Mr. Jay Mansour
Phone: 6789088180
Email: jay@mansourconsulting.com

Date Prepared: 2025-08-14

Name of Device

Trade Names: Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
Common Name: Non-powdered surgeon's glove
Classification Name: Surgeon's Gloves
Classification Regulation: 21 CFR 878.4460
Device Class: I
Product Code: KGO, LZC
Classification Panel: General and Plastic Surgery

Legally Marketed Predicate Device

Primary Predicate: K160781
Sempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons Gloves

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HARPS Europe Manufacturing GmbH K250313
Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
2 of 8

Device Description

Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is a sterile and disposable device. This glove is made of synthetic polyisoprene rubber inside coated with synthetic material to ease donning the glove. The device is intended to be worn on hands, usually in surgical settings, to provide a barrier against potentially infectious materials and other contaminants. These gloves were tested for use with Chemotherapy Drugs and Gastric Acid as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs.

The device conforms to the following FDA recognized consensus standards: ASTM D3577-19, ASTM D6124-06, ASTM D5151-19, ASTM D412-16, ISO 11137-1:2006 + AMD1:2013 + AMD2:2018, ISO 11137-2:2013 + AMD1:2022, and ASTM D6978-05.

Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is available in the following sizes: 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, and 9.0.

Indication for Use Statement

The Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination.

The tested drugs are:

CompoundMinimum Breakthrough Time (minutes)
Carmustine (BCNU) (3.3 mg/ml)15.8
Cyclophosphamide (20 mg/ml)>240
Doxorubicin (2 mg/ml)>240
Etoposide (Toposar) (20 mg/ml)>240
Fluorouracil (50 mg/ml)>240
Paclitaxel (6 mg/ml)>240
Thiotepa (THT) (10 mg/ml)24.6
Bleomycin sulfate (15 mg/ml)>240
Carboplatin (10 mg/ml)>240
Cisplatin (1 mg/ml)>240
Cytarabine (100 mg/ml)>240
Dacarbazine (10 mg/ml)>240
Daunorubicin HCl (5 mg/ml)>240
Docetaxel (10 mg/ml)>240
Gemcitabine HCl (38 mg/ml)>240
Idarubicin HCl (1 mg/ml)>240
Ifosfamide (50 mg/ml)>240
Irinotecan HCl (20 mg/ml)>240
Mechlorethamine HCl (1 mg/ml)>240
Melphalan HCl (5 mg/ml)>240
Methotrexate (25 mg/ml)>240

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HARPS Europe Manufacturing GmbH K250313
Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
3 of 8

| Mitomycin C (0.5 mg/ml) | >240 |
| Mitoxantrone (2 mg/ml) | >240 |
| Vincristine Sulfate (1 mg/ml) | >240 |
| Busulfan (6 mg/ml) | >240 |
| Chloroquine (50 mg/ml) | >240 |
| Cyclosporin A (100 mg/ml) | >240 |
| Epirubicin HCl (2 mg/ml) | >240 |
| Fludarabine Phosphate (25 mg/ml) | >240 |
| Oxaliplatin (2 mg/ml) | >240 |
| Retrovir (10 mg/ml) | >240 |
| Rituximab (10 mg/ml) | >240 |
| Topotecan HCl (1 mg/ml) | >240 |
| Trisenox (Arsenic Trioxide) (1 mg/ml) | >240 |
| Velcade (Bortezomib) (1 mg/ml) | >240 |

Simulated Gastric Acid Fluid was also tested with a minimum breakthrough greater than 240 minutes.

WARNING:
Please note the following drugs have extremely low permeation times:
Carmustine: 15.8 minutes and Thiotepa: 24.6 minutes. Do not use with Carmustine and Thiotepa.

Technological Characteristics

Predicate DeviceSubject DeviceComparison
Trade nameSempermed Syntegra IR, Sterile Powder Free Synthetic Rubber Surgeons GlovesSterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric AcidDifferent
510k NumberK160781K250313Different
Product OwnerSempermed USA Inc.HARPS Europe Manufacturing GmbHDifferent
Product CodeKGOKGO, LZCSame
Regulation Number21 CFR 878.446021 CFR 878.4460Same
Regulatory ClassIISame
Regulation NameNon-powdered Surgeon's GlovesNon-powdered Surgeon's gloveSame
Indications For UseThe Sterile Powder Free Synthetic Rubber Gloves is a single use disposable device intended to be worn by operating roomThe Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With ChemotherapyDifferent - Added chemotherapy and gastric acid testing

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Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
4 of 8

| | | personnel to protect a surgical wound from contamination. | Drugs and Gastric Acid is a single use disposable device intended to be worn by operating room personnel to protect a surgical wound from contamination. The tested drugs are: (table of tested drugs removed for clarity) Simulated Gastric Acid Fluid was also tested with a minimum breakthrough greater than 240 minutes. WARNING: Please note the following drugs have extremely low permeation times: Carmustine: 15.8 minutes and Thiotepa: 24.6 minutes. Do not use with Carmustine and Thiotepa. | |
| Material | Synthetic polyisoprene rubber | Synthetic polyisoprene rubber | Similar |
| Coating | Synthetic polymeric inner coating | Synthetic polymeric inner coating | Similar |
| Design | Single use | Single use | Same |
| Design | Powder-free | Powder-free | Same |
| Design | Anatomical shape with curved fingers | Anatomical shape with curved fingers | Same |
| Design | Beaded cuff | Beaded cuff | Same |
| Color | Natural color | Green | Different |
| Labeling | Surgeon's Gloves | Surgeon's Gloves | Similar |
| Shelf Life | Not specified | No claimed shelf life | Similar |

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HARPS Europe Manufacturing GmbH K250313
Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid
5 of 8

Sterility Assurance Level10⁻⁶10⁻⁶
Sterilization ModalityNot specifiedRadiation
Surgical Glove ASTM D3577Meets requirementsMeets requirements
Dimensions ASTM D35775½, 6, 6½, 7, 7½, 8, 8½, and 95½, 6, 6½, 7, 7½, 8, 8½, and 9
Tensile Strength Before Aging ASTM D357717 MPa min17 MPa min
Ultimate Elongation Before Aging ASTM D3577650% min650% min
Stress at 500% Elongation Before Aging7.0 MPa min7.0 MPa min
Tensile Strength After Aging ASTM D357712 MPa min12 MPa min
Ultimate Elongation After Aging490 % min490 % min
Residual Powder ASTM D6124Does not exceed 2 mg/gloveDoes not exceed 2 mg/glove
Freedom From Holes ASTM D5151Meets ASTM D3577 requirementsMeets ASTM D3577 requirements
Biocompatibility In Vitro Cytotoxicity ISO 10993-5Not specifiedUnder the conditions of the study, failed with cytotoxicity grade 4
Biocompatibility Primary Skin Irritation ISO 10993-10Under the conditions of the study, the device is not an irritant.Under the conditions of the study, the device is not an irritant.
Biocompatibility Dermal Sensitization - ISO 10993-10Under the conditions of the study, the device is a non-sensitizer.Under the conditions of the study, the device is a non-sensitizer.
Biocompatibility Systemic Toxicity ISO 10993-11Not specifiedUnder the conditions of the study, the device does not exhibit

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acute systemic toxicity.
Biocompatibility Material Mediated Toxicity ISO 10993-11:2017Not specifiedUnder the conditions of the study, no pyrogenic response was observed.Different
Biocompatibility Bacterial Endotoxins Test USP <85>Not specifiedUnder conditions of the study, less than 20 EU/deviceDifferent

Comparison Between Predicate and Proposed:

Differences in Trade Name, 510k Number, Product Owner, Color, and Sterilization Modality do not directly affect the performance or use of the devices.

Chemotherapy Testing: The predicate device was not tested for permeation of chemotherapy drugs or gastric acid. The safety and efficacy of the proposed device with respect to chemotherapy drugs and gastric acid is addressed through the performance testing and labeling of the device.

Shelf Life: There is no claimed shelf life for the proposed device.

The subject and predicate devices meet the applicable requirements for surgeon's gloves with regards to dimensions and sizes, physical properties, freedom from holes, and powder residues as found in the following standards: ASTM D3577, ASTM D5151 and ASTM D6124. The subject device passes biological reactivity testing for dermal sensitization, irritation, acute systemic toxicity, and material-mediated pyrogenicity in accord with the ISO 10993 series of standards.

Non-Clinical Testing

Sterile Powder Free Synthetic Rubber Surgeon's Gloves, Green Color, Tested For Use With Chemotherapy Drugs and Gastric Acid has the following technological characteristics as compared to ASTM or equivalent standards:

Title of TestPurpose of TestAcceptance CriteriaResults
ASTM D3577-19DimensionsMeets criteria in accordance with ASTM D3577-19: Standard Specification for Rubber Surgical GlovesPASS
ASTM D3577-19Physical PropertiesMeets criteria for tensile strength, ultimate elongation and stress at 500% elongation before and after accelerated aging for synthetic surgicalPASS

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gloves per ASTM D3577-19: Standard Specification for Rubber Surgical Gloves
ASTM D5151-19Freedom from holesMeets criteria in accordance with ASTM D3577-19: Standard Specification for Rubber Surgical Gloves with AQL requirements of 0.65PASS
ASTM D6124Powder-FreeMeets applicable acceptance criteria for powder free ≤ 2mg per glove per ASTM D3577-19: Standard Specification for Rubber Surgical GlovesPASS
ISO 11137-1:2006SterilityMeets acceptance criteria requirement of 10⁻⁶ SAL per ISO 11137-1: Sterilization for health care products – Radiation – Part 1: Requirements for development, validation and routine control of a sterilization process for medical devicesPASS
ASTM D6978-05Chemotherapy Drug Permeation TestTesting performed in accordance with ASTM D6978-05: Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs.PASS
ISO 10993-10:2010Biocompatibility: Skin IrritationPasses Primary Skin Irritation test per ISO 10993-10, Biological Evaluation of medical devices, Part 10: Test for irritation and skin sensitization. Under the conditions of the study, not an irritant.PASS
ISO 10993-10:2010Biocompatibility: Dermal SensitizationPasses Dermal Sensitization test per ISO 10993-10, Biological Evaluation of medical devices, Part 10: Test for irritation and skin sensitization. Under the conditions of the study, not a sensitizer.PASS

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ISO 10993-11:2017Biocompatibility: Acute Systemic ToxicityPasses Acute Systemic Toxicity Test per ISO 10993-11, Biological Evaluation of medical devices, Part 11: Test for systemic toxicity. Under the conditions of the study, there was no mortality or evidence of acute systemic toxicity.PASS
ISO 10993-11:2017Biocompatibility: Material-Mediated PyrogenicityPasses Material-Mediated Pyrogenicity Test per ISO 10993-11, Biological Evaluation of medical devices, Part 11: Test for systemic toxicity. Under the conditions of the study, no pyrogenic response was observed.PASS
USP <85>Endotoxin TestingMeets acceptance criteria for bacterial endotoxins per USP <85> Bacterial Endotoxins Test. Endotoxin level ≤ 20 EU/device.PASS

Clinical Studies

A clinical study was not conducted in support of this submission.

Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the subject device is as safe, as effective, and performs as well as or better than the legally marketed predicate device K160781.

§ 878.4460 Non-powdered surgeon's glove.

(a)
Identification. A non-powdered surgeon's glove is a device intended to be worn on the hands of operating room personnel to protect a surgical wound from contamination. A non-powdered surgeon's 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).