← Product Code [KGO](/submissions/SU/subpart-e%E2%80%94surgical-devices/KGO) · K161823
# Powder Free Nitrile Surgical Glove, Sterile, Tested for use with Chemotherapy Drugs (K161823)
_Wrp Asia Pacific Sdn. Bhd. · KGO · Jan 23, 2017 · General, Plastic Surgery · SESE_
**Canonical URL:** https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K161823
## Device Facts
- **Applicant:** Wrp Asia Pacific Sdn. Bhd.
- **Product Code:** [KGO](/submissions/SU/subpart-e%E2%80%94surgical-devices/KGO.md)
- **Decision Date:** Jan 23, 2017
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 878.4460
- **Device Class:** Class 1
- **Review Panel:** General, Plastic Surgery
## Intended Use
A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination. The device has also been tested for use with chemotherapy drugs.
## Device Story
Powder-free, sterile, hand-specific nitrile surgical glove; manufactured from synthetic rubber latex. Inner surface treated for smooth donning without powder. Used by operating room personnel to protect surgical wounds. Tested for permeation resistance against 12 chemotherapy drugs per ASTM D6978-05. Provides barrier protection; output is physical protection of the surgical site. Benefits include reduced risk of wound contamination and protection of personnel from chemotherapy drug exposure.
## Clinical Evidence
No clinical data. Substantial equivalence supported by bench testing including ASTM D3577-09 (physical properties), ASTM D6978-05 (chemotherapy permeation), ASTM D5151-06 (watertightness), ASTM D6124-06 (powder content), and ISO 10993-10 (biocompatibility/irritation/sensitization).
## Technological Characteristics
Material: Nitrile synthetic rubber. Form: Sterile, hand-specific, powder-free, micro-roughened texture. Dimensions: Min length 270mm, min thickness 0.10mm. Standards: ASTM D3577-09, D6978-05, D5151-06, D6124-06. Biocompatibility: ISO 10993-10. Connectivity: None. Energy source: None.
## Regulatory 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.
## Predicate Devices
- Cardinal Health Sterile Neoprene Powder-free Surgical Gloves with Nitrile Coating ([K153316](/device/K153316.md))
- SensiCare PI Surgical Gloves ([K152428](/device/K152428.md))
## Submission Summary (Full Text)
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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized caduceus or a series of interconnected human profiles.
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
January 23, 2017
WRP Asia Pacific Sdn Bhd Sarala Jayaraman Regulatory Affairs Manager Lot 1, Jalan 3, Kaw Perusahaan Bandar Baru Salak Tinggi Sepang, 43900 MY
Re: K161823
Trade/Device Name: Powder Free Nitrile Surgical Glove, Sterile, Tested for use with Chemotherapy Drugs Regulation Number: 21 CFR 878.4460 Regulation Name: Surgeon's Glove Regulatory Class: Class I Product Code: KGO, LZC
Dated: December 15, 2016
Received: December 19, 2016
Dear Sarala Jayaraman:
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.
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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in
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the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.
If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address
http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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
http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.
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 (800) 638-2041 or (301) 796-7100 or at its Internet address
http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.
Sincerely.
Michael J. Ryan -S
for Tina Kiang, Ph.D. Acting 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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## DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration
## Indications for Use
Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page.
### 510(k) Number (if known) K161823
### Device Name
Powder Free Nitrile Surgical Glove, Sterile, Tested for use with Chemotherapy Drugs
## Indications for Use (Describe)
A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination.
These gloves were tested for use with Chemotherapy Drugs as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs:
### Chemotherapy Drug Permeation
The following chemicals have been tested with these gloves.
| Chemotherapy Drug | Concentration | Breakthrough Detection Time in Minutes |
|----------------------------|---------------|----------------------------------------|
| *Carmustine (BCNU) | 3.3mg/ml | 30.4 |
| Cisplatin | 1.0mg/ml | > 240 |
| Cyclophosphamide (Cytoxan) | 20.0mg/ml | > 240 |
| Dacarbazine | 10.0mg/ml | > 240 |
| Doxorubicin Hydrochloride | 2.0mg/ml | > 240 |
| Etoposide (Toposar) | 20.0mg/ml | > 240 |
| Fluorouracil | 50.0mg/ml | > 240 |
| Ifosfamide | 50.0mg/ml | > 240 |
| Mitoxantrone | 2.0mg/ml | > 240 |
| Paclitaxel (Taxol) | 6.0mg/ml | > 240 |
| *Thiotepa | 10.0mg/ml | 59.0 |
| Vincristine Sulfate | 1.0mg/ml | > 240 |
CAUTION: Testing showed an average breakthrough time of 30.4 minutes for Carmustine and an average breakthrough time of 59.0 minutes for Thiotepa.
Type of Use (Select one or both, as applicable)
[] Prescription Use (Part 21 CFR 801 Subpart D)
区 Over-The-Counter Use (21 CFR 801 Subpart C)
## PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.
### FOR FDA USE ONLY
Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)
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#### 1.0 Submitter:
| Name: | Sarala Devi Jayaraman |
|------------|------------------------------------------------------------------------------------------------------------------------------------------|
| Address: | WRP Asia Pacific Sdn Bhd
Lot 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: 12 January 2017
#### 2.0 Name of the modified device Identification:
Powder Free Nitrile Surgical Glove, Sterile, Tested for use with Chemotherapy Drugs 510(k) Number: K161823 Common Name: Surgical Gloves Classification Name: Surgeon's Gloves (21 CFR 878.4460 product code KGO) Patient Examination Gloves Specialty (21 CFR 880.6250 product code LZC)
### 3.0 Identification of The Legally Marketed Devices that equivalency is claimed:
| | Predicate 1 | Predicate 2 |
|------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------|
| Manufacturer | Cardinal Health
200, LLC | Medline
Industries,
Incorporated |
| Device name | Cardinal Health™
Sterile Neoprene
Powder-free
Surgical Gloves
with Nitrile
Coating and
Tested for Use
with
Chemotherapy
Drugs
(Yellow) | SensiCare PI
Surgical Gloves |
| 510(k) Number | K153316 | K152428 |
| Regulatory Class | I | I |
| Product Code | KGO, LZC | KGO, LZC |
#### 4.0 Description of The Device:
Powder Free Nitrile Surgical Glove, Sterile meets all the requirements of ASTM standard D3577-09, D6978-05 and FDA 21 CFR 878.4460.
The powder free nitrile surgical glove is manufactured from synthetic rubber latex. 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 hand specific. The physical properties of glove i.e. tensile strength meet ASTM standard D3577-09.
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### 5.0 Intended Use of the Device:
A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by operating room personnel to protect a surgical wound from contamination. The device has also been tested for use with chemotherapy drugs.
These gloves were tested for use with Chemotherapy Drugs as per ASTM D6978-05 Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs:
| Chemotherapy Drug Permeation | | |
|-------------------------------------------------------------|---------------|-------------------------------------------|
| The following chemicals have been tested with these gloves. | | |
| Chemotherapy Drug | Concentration | Breakthrough Detection
Time in Minutes |
| *Carmustine (BCNU) | 3.3mg/ml | 30.4 |
| Cisplatin | 1.0mg/ml | > 240 |
| Cyclophosphamide (Cytoxan) | 20.0mg/ml | > 240 |
| Dacarbazine | 10.0mg/ml | > 240 |
| Doxorubicin Hydrochloride | 2.0mg/ml | > 240 |
| Etoposide (Toposar) | 20.0mg/ml | > 240 |
| Fluorouracil | 50.0mg/ml | > 240 |
| Ifosfamide | 50.0mg/ml | > 240 |
| Mitoxantrone | 2.0mg/ml | > 240 |
| Paclitaxel (Taxol) | 6.0mg/ml | > 240 |
| *Thiotepa | 10.0mg/ml | 59.0 |
| Vincristine Sulfate | 1.0mg/ml | > 240 |
CAUTION: Testing showed an average breakthrough time of 30.4 minutes for Carmustine and an average breakthrough time of 59.0 minutes for Thiotepa.
### 6.0 Summary of the Technological Characteristics of the Device:
The Powder Free Nitrile Surgical Glove, Sterile are summarized with the following technological characteristics compared to ASTM D3577 or equivalent standards as shown in Table 1
Compliant to chemotherapy claim whereby glove thickness and length meets minimal thickness of 0.10 mm and minimal length of 270 respectively.
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## Table 1
| CHARACTERISTICS | STANDARDS | DEVICE PERFORMANCE | | |
|-------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | | Predicate 1 | Predicate 2 | Current |
| Manufacturer(s) | | Cardinal Health
200, LLC | Medline Industries,
Incorporated | WRP Asia Pacific
Sdn Bhd |
| 510(k) Number | | K153316 | K152428 | K161823 |
| Intended use | - | A powder-free
sterile surgeon's
glove is
a disposable device
made of synthetic
rubber intended to
be worn by
operating
room personnel to
protect a surgical
wound from
contamination.
In addition, these
gloves were tested
for
use with
chemotherapy
drugs in
accordance with
ASTM D6978
Standard Practice
for Assessment of
Medical Gloves to
Permeation by
Chemotherapy
Drugs. | The SensiCare PI
surgeon's
glove is a
disposable device
made of synthetic
rubber
intended to be
worn by operating
room personnel to
protect a
surgical wound
from
contamination. In
addition, these
gloves were tested
for use with
chemotherapy
drugs in
accordance with
ASTM D6978
Standard Practice
for Assessment
of Medical Gloves to
Permeation
by Chemotherapy
Drugs.
Warning: Do not
use with
Carmustine and
Thiotepa | A powder-free
sterile surgeon's
glove is a
disposable device
made of synthetic
rubber intended to
be worn by
operating room
personnel to
protect a surgical
wound from
contamination. In
addition, these
gloves were tested
for
use with
chemotherapy
drugs in
accordance with
ASTM D6978
Standard Practice
for Assessment of
Medical Gloves to
Permeation by
Chemotherapy
Drugs.
*CAUTION: Testing
showed an average
breakthrough time
of 30.4 minutes for
Carmustine and an
average
breakthrough time
of 59.0 minutes for
Thiotepa. |
| Material | ASTM D3577-
09 | Synthetic Neoprene
Polymer coated with
Nitrile | Synthetic
Polyisoprene | Nitrile |
| Color | - | Yellow | Cream colored.
Contains a
blend of three
colorants
(naphthos AS red, azo
yellow and carbon
black) | Natural |
| Texture | | | - | Micro roughened |
| CHARACTERISTICS | STANDARDS | DEVICE PERFORMANCE | | |
| | | | | |
| 510(k) Number | ASTM D3577-09 | Predicate 1
K153316 | Predicate 2
K152428 | Current
K161823 |
| Dimensions | ASTM D3577-09 | Meets | Meets | Meets |
| Length | ASTM D3577-09 | Min 270mm | Min 270mm | Min 270mm |
| Width | ASTM D3577-09 | Meets | Meets
5 ½ : 70±6mm
6 : 76±6mm
6 ½ : 83±6mm
7 : 89±6mm
7 ½ : 95±6mm
8 : 102±6mm
8 ½ : 108±6mm
9 : 114±6mm | Meets
5 ½ : 70±6mm
6 : 76±6mm
6 ½ : 83±6mm
7 : 89±6mm
7 ½ : 95±6mm
8 : 102±6mm
8 ½ : 108±6mm
9 : 114±6mm |
| Thickness
- Finger
- Palm
- Cuff | ASTM D3577-09 | Meets | Meets
Min 0.10mm
Min 0.10mm
Min 0.10mm | Meets
Min 0.10mm
Min 0.10mm
Min 0.10mm |
| Physical Properties
Before Aging
Tensile Strength :
Ultimate
Elongation :
Stress at 500%
Elongation : | ASTM D3577-09 | Meets | Meets
7MPa min
650% min
7.0MPa min | Meets
7MPa min
650% min
7.0MPa min |
| Physical Properties
After Aging
Tensile Strength :
Ultimate
Elongation : | ASTM D3577-09 | Meets | Meets
12MPa min
490% min | Meets
12MPa min
490% min |
| Watertight
(1000ml) | ASTM D5151-06 | Meets 21CFR
800.20 & ASTM
D3577
requirements of
AQL 1.5 | Meets 21 CFR
800.20 and
ASTM D3577
when tested in
accordance with
ASTM D5151
Inspection Level
1, AQL 1.5 | Meets 21 CFR
800.20 and
ASTM D3577
when tested in
accordance with
ASTM D5151
Inspection Level
1, AQL 1.5 |
| Powder Free | ASTM D6124-06
(≤ 2 mg/glove) | Meets
requirements of
≤2.0 mg/glove
for Powder-Free
designation per
ASTM D3577 | <2mg of residual
powder when
tested in
accordance with
ASTM D3577 | Meets
requirements of
≤2.0 mg/glove
for Powder-Free
designation per
ASTM D3577 |
| CHARACTERISTICS | STANDARDS | DEVICE PERFORMANCE | | |
| | | Predicate 1 | Predicate 2 | Current |
| 510(k) Number | | K153316 | K152428 | K161823 |
| Chemotherapy Drug
Permeation Test | ASTM D6978-05 | | | |
| Test
Chemotherapy
Drug | Concentration | Minimum Breakthrough Detection Time (min) | | |
| *Carmustine (BCNU) | 3.3mg/ml | 60.1 | 10.1 | 30.4 |
| Cisplatin | 1.0mg/ml | > 240 | > 240 | > 240 |
| Cytarabine | 100.0mg/ml | | > 240 | - |
| Cyclophosphamide
(Cytoxan) | 20.0mg/ml | > 240 | > 240 | > 240 |
| Dacarbazine | 10.0mg/ml | - | > 240 | > 240 |
| Doxorubicin
Hydrochloride | 2.0mg/ml | > 240 | > 240 | > 240 |
| Etoposide (Toposar) | 20.0mg/ml | > 240 | > 240 | > 240 |
| Fluorouracil | 50.0mg/ml | > 240 | > 240 | > 240 |
| Ifosfamide | 50.0mg/ml | - | > 240 | > 240 |
| Methotrexate | 25.0mg/ml | > 240 | > 240 | - |
| Mitoxantrone | 2.0mg/ml | - | > 240…
---
**Source:** [https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K161823](https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K161823)
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