Powder Free Vinyl Patient Examination Gloves (Green)

K152692 · Supermax Plastic Products Co., Ltd. · LYZ · Dec 21, 2015 · General Hospital

Device Facts

• Record ID: K152692
• Device Name: Powder Free Vinyl Patient Examination Gloves (Green)
• Applicant: Supermax Plastic Products Co., Ltd.
• Product Code: LYZ · General Hospital
• Decision Date: Dec 21, 2015
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.6250
• Device Class: Class 1

Intended Use

The Powder Free Vinyl Patient Examination Gloves (Green) is disposable non-sterile device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

Device Story

Disposable, non-sterile vinyl patient examination gloves; worn on examiner's hand or finger; acts as a flexible barrier film to prevent cross-contamination between patient and examiner; used in clinical settings; no electronic or software components.

Clinical Evidence

No clinical data included. Substantial equivalence supported by bench testing, including ASTM D5250-06(2011) for physical properties, ASTM D5151-06(2011) for pinholes, ASTM D6124-06(2011) for residual powder, and ISO 10993-10 for skin irritation and sensitization.

Technological Characteristics

Material: Polyvinyl Chloride (PVC). Form factor: Disposable, non-sterile, powder-free gloves. Sizes: S, M, L, XL. Standards: ASTM D5250-06(2011), ASTM D5151-06(2011), ASTM D6124-06(2011). Biocompatibility: ISO 10993-10. No electronic, software, or energy-based components.

Indications for Use

Indicated for use as a disposable, non-sterile medical glove worn on the examiner's hand or finger to prevent cross-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

• Powder-Free Yellow Vinyl Patient Examination Gloves (K141878)

Submission Summary (Full Text)

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

December 21, 2015

Supermax Plastic Products Co., Ltd % Ms. Kathy Liu Project Manager Hongray USA Medical Products Inc. 3973 Schaefer Ave. Chino, California 91710

Re: K152692

Trade/Device Name: Powder Free Vinyl Patient Examination Gloves (Green) Regulation Number: 21 CFR 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LYZ Dated: November 24, 2015 Received: November 27, 2015

Dear Ms. Liu:

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. 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 809); medical device reporting of medical device-related adverse events) (21 CFR 803); 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.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Tejashri Purohit-Sheth, M.D.

Tejashri Purohit-Sheth, M.D. Clinical Deputy Director DAGRID/ODE/CDRH FOR

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, 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) K152692

Device Name

Powder Free Vinyl Patient Examination Gloves (Green)

Indications for Use (Describe)

The Powder Free Vinyl Patient Examination Gloves (Green) is disposable non-sterile device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

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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# Supermax Plastic Products Co., Ltd.

314 Dragon River East Road, Luquan, Hebei Province, CHINA 050000

## 510(K) SUMMARY

This summary of 510(K) safety and effectiveness information is being submitted in accordance with requirements of 21 CFR \$807.92.

The assigned 510(K) number is: K152692

#### 1. Owner's Identification :

Mr. Wu Zhigang Supermax Plastic Products Co., Ltd. 314 Dragon River East Road, Luquan, Hebei Province, CHINA 050000

Tel: [phone] Fax: [phone]

Contact: Ms. Kathy Liu, Project Manager Address: 3973 Schaefer Ave., Chino, CA 91710 Tel: [phone] Fax: [phone] Date Summary Prepared: December 15, 2015

## 2. Name of the Device:

Trade Name: Powder Free Vinyl Patient Examination Gloves (Green) Common Name: Patient Examination Gloves Classification Name: Patient Examination Glove Classification Regulation: 21 CFR 880.6250 Classification Panel: 80 General Hospitals Product Code: LYZ Device Class: Class I

## 3. Predicate Device Information:

Tangshan Hongyun Plastic Products Company Limited Powder-Free Yellow Vinyl Patient Examination Gloves (K141878)

#### 4. Device Description:

Powder Free Vinyl Patient Examination Gloves (Green) are Patient Examination Gloves, Disposable, single use only and non-sterile. The gloves are made of vinyl materials and are powder free. The physical and performance characteristics of the devices meet all requirements of ASTM D5250-06 (Reapproved 2011)--Standard Specification For Poly (Vinyl Chloride) Gloves For Medical Application.

#### 5. Intended Use of the Device:

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# Supermax Plastic Products Co., Ltd.

314 Dragon River East Road, Luquan, Hebei Province, CHINA 050000

The Powder Free Vinyl Patient Examination Gloves (Green) is disposable non-sterile device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner.

#### 6. Technological Characteristics and Substantial Equivalence:

Supermax Plastic Products Co., Ltd.'s Powder Free Vinyl Patient Examination Gloves (Green) is substantially equivalent in safety and effectiveness to the Tangshan Hongyun Plastic Products Company Limited's Powder-Free Yellow Vinyl Patient Examination Gloves (K141878). The subject device and predicate device use a similar plastic flexible barrier film to achieve a device for the intended use.

And the properties between the subject device and the predicate device are compared in the following table:

| Characteristics | Standard | Device Performance | | Result of |
|-------------------------------------------------------------------------|------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|
| | | Predicate device | Subject Device | comparison |
| 510K number | | K141878 | K152692 | -- |
| Product name | 1 | Powder-Free Yellow Vinyl<br>Patient Examination<br>Gloves | Powder Free Vinyl<br>Patient Examination<br>Gloves (Green) | Similar |
| Product Code | | LYZ | LYZ | Same |
| Intended Use | | Powder-Free Yellow Vinyl<br>Patient Examination<br>Gloves is a non sterile<br>disposable device intended<br>for medical purposes that is<br>worn on the examiner's<br>hand or finger to prevent<br>contamination between<br>patient and examiner. | The Powder Free Vinyl<br>Patient Examination<br>Gloves (Green) is<br>disposable non-sterile<br>device intended for<br>medical purpose that is<br>worn on the examiner's<br>hand or finger to prevent<br>contamination between<br>patient and examiner. | Same |
| Size | | S/M/L/XL | S/M/L/XL | Same |
| Compare all<br>materials used<br>to fabricate the<br>devices | | PVC | PVC | Same |
| Dusting or<br>Donning<br>powder | | PU | PU | Same |
| Compare<br>performance<br>data supporting<br>substantial<br>equivalence | | Meets<br>ASTM D5151-06(2011)<br>ASTM D 5250-06 (2011)<br>ASTM D6124-06(2011) | Meets<br>ASTM D5151-06(2011)<br>ASTM D 5250-06 (2011)<br>ASTM D6124-06(2011) | Same |
| Color | | Yellow | Green | Similar |
| | Standard | Device Performance | | Result of |
| Characteristics | | Predicate device | Subject Device | comparison |
| Single patient<br>use | / | Single patient use | Single patient use | Similar |
| Dimensions:<br>Length | ASTM D 5250-<br>06 (2011) | Meets<br>230 mm min for all sizes | Meets<br>230 mm min for all sizes | Similar |
| Dimensions:<br>Width | ASTM D 5250-<br>06 (2011) | Meets<br>S: 83-86 mm<br>M: 94-97 mm<br>L: 104-107 mm<br>XL: 113-115 mm | Meets<br>S: 85±5 mm<br>M: 95±5 mm<br>L: 105±5 mm<br>XL: 115±5 mm | Similar |
| Dimensions:<br>Thickness | ASTM D 5250-<br>06 (2011) | Meets<br>Palm: 0.08 mm min<br>Finger: 0.05 mm min | Meets<br>Palm: 0.08 mm min<br>Finger: 0.05 mm min | Similar |
| Tensile<br>strength:<br>before<br>and<br>after aging | ASTM D 5250-<br>06 (2011) | Meets<br>Tensile Strength≥11MPa | Meets<br>Tensile Strength≥11MPa | Similar |
| Elongation<br>before and after<br>aging | ASTM D 5250-<br>06 (2011) | Meets<br>Elongation≥300% | Meets<br>Elongation≥300% | Similar |
| Freedom from<br>pinholes | ASTM D 5250-<br>06 (2011)<br>ASTM D5151-<br>06<br>(Reapproved<br>2011) | Meets<br>G-I, AQL2.5 | Meets<br>G-I, AQL2.5 | Similar |
| Residual<br>powder | ASTM D 5250-<br>06 (2011)<br>ASTM D6124-<br>06(Reaffirmati<br>on 2011) | Meets<br>Results below 2mg of<br>residual powder | Meets<br>Not more than 2mg per<br>glove | Similar |
| Biocompatibility | Skin irritation<br>ISO 10993-10 | Under conditions of<br>the<br>study, not an irritant | Under conditions of the<br>study, not an irritant | Same |
| | Sensitization<br>ISO 10993-10 | Under the conditions of the<br>study, not a sensitizer | Under the conditions of<br>the study, not a sensitizer | Same |
| Labeling | / | Powder Free<br>Devices color: Yellow<br>Patient examination Glove<br>Non Sterile<br>Single use only<br>Manufactured for:<br>Lot | Powder Free<br>Devices color: Green<br>Patient examination<br>Glove<br>Non Sterile Single<br>use only<br>Manufactured for:<br>Lot | Similar |

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Supermax Plastic Products Co., Ltd.
314 Dragon River East Road, Luquan, Hebei Province, CHINA 050000

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# Supermax Plastic Products Co., Ltd.

314 Dragon River East Road, Luquan, Hebei Province, CHINA 050000

Powder Free Vinyl Patient Examination Gloves (Green) shares the same or comparable technology characteristics compared to the predicate device. The subject device performs according to the glove performance standards ASTM D5250-06(2011), biocompatibility requirement and FDA requirements and the labeling claims for the product. It performs as well as the legally marketed predicate device.

#### 7. Discussion of Non-Clinical Tests Performed for Determination of Substantial Equivalence is as Follows:

Powder Free Vinyl Patient Examination Gloves (Green) meet requirements per ASTM D 5250-06(2011), per ASTM D6124-06 (2011), ASTM D5151-06(2011), 21CFR 800.20 and ISO 10993-10 third edition 2010-08-01

#### 8. Discussion of Clinical Tests Performed:

Clinical data was not included in the submission. Substantial equivalence of the subject device was supported by non-clinical testing.

## 9. Conclusions:

Powder Free Vinyl Patient Examination Gloves (Green) conform fully to ASTM D 5250-06 (2011) standard as well as applicable 21 CFR references, and meets pinhole FDA requirements, biocompatibility requirements and labeling claims as shown by data discussed above.

Drawn from the complete list of non-clinical tests, the subject device is as safe, as effective, and performs as well as the legally marketed predicate device. The subject device is substantially equivalent to the predicate device.