NON-STERILE, POWDER FREE NITRILE EXAMINATION GLOVE, BLUE WITH POLYMER COATING, MODEL BLUE: ALL SIZES (XS-XL)

K060753 · Siam Sempermed Corp., Ltd. · LZA · Apr 27, 2006 · General Hospital

Device Facts

• Record ID: K060753
• Device Name: NON-STERILE, POWDER FREE NITRILE EXAMINATION GLOVE, BLUE WITH POLYMER COATING, MODEL BLUE: ALL SIZES (XS-XL)
• Applicant: Siam Sempermed Corp., Ltd.
• Product Code: LZA · General Hospital
• Decision Date: Apr 27, 2006
• Decision: SESE
• Submission Type: Abbreviated
• Regulation: 21 CFR 880.6250
• Device Class: Class 1

Intended Use

This device is a disposable device intended for medical purpose that is worn on the examiner 's hand to prevent contamination between patient and examiner.

Device Story

Non-sterile, powder-free nitrile examination glove with polymer coating; worn by healthcare examiners on hands/fingers; acts as a physical barrier to prevent cross-contamination between patient and examiner; used in clinical settings; disposable.

Clinical Evidence

Bench testing only. Testing included dimensions, physical properties, freedom from pinholes (ASTM D6319-00-ae3), powder-free residue (ASTM D6124-2001), and biocompatibility (primary skin irritation and guinea pig sensitization). All tests passed.

Technological Characteristics

Nitrile examination glove with polymer coating. Meets ASTM D6319-00-ae3 for dimensions, physical properties, and pinhole freedom. Meets ASTM D6124-2001 for powder-free residue (≤2 mg/glove). Biocompatibility confirmed via skin irritation and sensitization testing.

Indications for Use

Indicated for use as a disposable patient examination glove worn on the examiner's hand or finger to prevent contamination between patient and examiner.

Regulatory Classification

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.

Predicate Devices

• Siam Sempermed Nitrile, Examination Glove, Blue, Powder free (K000323)

Submission Summary (Full Text)

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α0753

# 510 (k) Summary

As Required by 21 section 807.92 (c)

APR 2 7 2006

- 1. Submitter Name: Siam Sempermed Corp., Ltd
- 2. Address: 110 Kanjanavanit Road. Pathong Hatyai Songkhla. Thailand 90230
- 3. Phone: [phone]
- বে Fax: [phone]

ર્જ Contract Person: Mrs. Sureerat Choosri (Product Manager)

- 6. Date summary prepared: December 30, 2005
- 7. Official Correspondent: Sempermed USA Inc.
- 8. 13900 49th Street North Address: Clearwater, USA , FL 33762
- 9. Phone: [phone]
- 10. Fax: [phone]
- 11. Contact person: Mr. William E. Harris

12. Device Trade or Proprietary Name: Non sterile, Powder free Nitrile Examination Glove, Blue with Polymer coating

13. Device Common or usual name: Examination glove

14. Device Classification Name: Nitrile Patient Examination Glove (Powder free, Blue color)

- 15. Description of the Device:
Non sterile, Powder free Nitrile Examination Glove, Blue with Polymer toating

#### 16. Intended use of the device:

This device is a disposable device intended for medical purpose that is worn on the examiner 's hand to prevent contamination between patient and examiner.

### 17. Summary of The Technological Characteristics of The devices:

Non sterile, Powder free Nitrile Examination Glove, Blue with Polymer coated are summarized with the following technological characteristics compared to ASTM or equivalent standards.

| CHARACTERISTICS | STANDARDS | DEVICE PERFORMANCE |
|-----------------------|------------------------------------|--------------------|
| Dimensions | ASTM D 6319-00-ae3 | Meets |
| Physical Properties | ASTM D 6319-00-ae3 | Meets |
| Freedom from pinholes | ASTM D 6319-00-ae3 | Meets |
| Powder Free Residue | ASTM D 6124-2001 | ≤2 mg/glove |
| Biocompatibility | Primary Skin Irritation in Rabbits | Passes |
| | Guinea Pig Sensitization | Passes |

## 18. Substantial Equivalents Based on Assessment of Non-Clinical Performance Data

The performance test data of the non-clinical tests that support a determination of substantial equivalence is the same as mentioned immediately above.

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K060753

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#### 19. Conclusion

It can be concluded that the Non sterile, Powder free Nitrile Examination Glove, Blue with Polymer coating will perform according to the glove performance standards referenced in section 17 above and many ASTM standards, and FDA requirements. Consequently, this device is substantially equivalent to currently marketed devices. This device is safe and effective as the predicate device Siam Sempermed Nitrile, Evany intion Glove, Blue, Powder free. Indeed, it is equivalent. This is better expressed in the tabulated comparison as below.

Technical comparison of specific elements is attached in the main submission.

| FDA file reference number | 510k number: k000323 |
|-----------------------------------------------------|---------------------------------------------------------------------------------------------------|
| Attachments inside notification<br>submission file | REFER TO APPENDIX 1 |
| TECHNOLOGICAL<br>CHARACTERISTICS | Comparison result<br>REFER TO ADDITIONAL TECHNICAL<br>COMPARATIVE TABLE WITHIN 510K<br>SUBMISSION |
| Indications for use | Identical |
| Target population | Identical |
| Design | Similar |
| Materials | Similar |
| Performance | Identical |
| Sterility | Identical (Not applicable) |
| Biocompatibility | Identical |
| Mechanical safety | Identical |
| Chemical safety | Identical |
| Anatomical sites | Identical |
| Human factors | Identical |
| Energy used and/or delivered | Identical (Not applicable) |
| Compatibility with environment and<br>other devices | Identical |
| Where used | Identical |
| Standards met | Identical |
| Electrical safety | Identical (not applicable) |
| Thermal safety | Identical (not applicable) |
| Radiation safety | Identical (not applicable) |

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH AND HUMAN SERVICES, USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle with three lines extending from its head, resembling feathers or wings.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SIAM Sempermed Corporation. Limited C/O Mr. William E. Harris President & CEO Sempermed USA, Incorporated 13900 49th Street North Clearwater, Florida 33762

APR 2 7 2006

Re: K060753

Trade/Device Name: Non-Sterile, Powder-Free Nitrile Examination Glove, Blue with Polymer Coating Regulation Number: 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LZA Dated: March 21, 2006 Received: March 21, 2006

Dear Mr. Harris:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA). it may be subject to such 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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## Page 2 - Mr. Harris

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801). please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours.

Chiu Lin, Ph.D.

Director Division of Anesthesiology, General Hospital. Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known): K 0607 53

Non-sterile, Powder-Free Nitrile Examination Glove, Blue with Device Name: Polymer Coating Indications For 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 betweeen patient and examiner.

Prescription Use __ (Part 21 CFR 801 Subpart D) AND/OR

X Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Siale M. Luysey 4/24/64

logy, General Hospit
Medical Devices
K400753

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