← Product Code [KGO](/submissions/SU/subpart-e%E2%80%94surgical-devices/KGO) · K171047
# Sterile Polyisoprene Powder Free Surgical Gloves (K171047)
_Better Care Plastic Technology Co., Ltd. · KGO · Jun 22, 2017 · General, Plastic Surgery · SESE_
**Canonical URL:** https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K171047
## Device Facts
- **Applicant:** Better Care Plastic Technology Co., Ltd.
- **Product Code:** [KGO](/submissions/SU/subpart-e%E2%80%94surgical-devices/KGO.md)
- **Decision Date:** Jun 22, 2017
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 878.4460
- **Device Class:** Class 1
- **Review Panel:** General, Plastic Surgery
## Intended Use
This surgeon's glove is a sterile and single use device intended to be worn on the hands of operating room personnel to protect a surgical wound from contamination.
## Device Story
Sterile, single-use, powder-free surgical glove; manufactured from synthetic polyisoprene rubber with polyurethane inner coating for donning; hand-specific design with beaded cuff. Used by operating room personnel to provide barrier protection for surgical wounds against contamination. Device provides physical barrier; performance verified against ASTM D3577-09(2015) standards for dimensions, tensile strength, elongation, and freedom from holes. Biocompatibility confirmed via ISO 10993-10:2010 irritation and sensitization studies. Sterilization via radiation to 10^-6 SAL.
## Clinical Evidence
No clinical data. Bench testing only. Performance verified against ASTM D3577-09(2015) for dimensions, physical properties (tensile strength, elongation), and freedom from holes (AQL 1.5). Biocompatibility testing (ISO 10993-10:2010) confirmed device is not an irritant or sensitizer.
## Technological Characteristics
Material: Synthetic polyisoprene rubber with polyurethane inner coating. Standards: ASTM D3577-09(2015), ASTM D5151-06(2015), ASTM D6124-06(2011), ISO 10993-10:2010. Sterilization: Radiation (10^-6 SAL). Design: Hand-specific, beaded cuff, powder-free (≤ 2 mg/glove).
## 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
- Gammex PI Hybrid Surgical Glove ([K151694](/device/K151694.md))
## Submission Summary (Full Text)
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Public Health Service
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June 22, 2017
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
Better Care Plastic Technology Co., Ltd. % Kathy Liu Project Manager Hongray USA Medical Products Inc 2235 E Francis St Ontario. California 91761
Re: K171047
Trade/Device Name: Sterile Polyisoprene Powder Free Surgical Gloves Regulation Number: 21 CFR 878.4460 Regulation Name: Surgeon's Glove Regulatory Class: Class I Product Code: KGO Dated: May 17, 2017 Received: May 17, 2017
Dear Kathy 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.
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
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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 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.
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.
# Mark S. Fellman -S
for
Lori A. Wiggins, MPT, CLT 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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## Indications for Use
510(k) Number (if known) K171047
Device Name
Sterile Polyisoprene Powder Free Surgical Gloves
Indications for Use (Describe)
This surgeon's glove is a sterile and single use device intended to be worn on the hands of operating to protect a surgical wound from contamination.
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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Fuqian Xi Road, West district of Shenze Industrial Base, Shenze County, Hebei Province, CHINA 050000
#### 510(K) SUMMARY
This summary of 510(K) information is being submitted in accordance with requirements of 21 CFR 807.92.
The assigned 510(K) numbers: K171047
#### 1. Owner's Identification:
Mrs. Zhu Chunyan Better Care Plastic Technology Co., Ltd. Fuqian Xi Road, West district of Shenze Industrial Base, Shenze County, Hebei Province, CHINA 050000
Tel:86-311-83601854 Fax: 86-311-83616934
Contact: Ms. Kathy Liu, Project Manager Address: 2235 E Francis St, Ontario CA 91761 Tel:909-590-1611 Fax: 909-673-8347
Date Summary Prepared: March 23, 2017
#### 2. Name of the Device:
Trade Name: Sterile Polyisoprene Powder Free Surgical Gloves Common Name: Surgeon's Gloves Classification Name: Surgeon's Gloves Classification Regulation:21 CFR 878.4460 Product Code: KGO Classification Panel: General and Plastic Surgery Device Class: Class I
#### 3. Predicate Device Information:
Ansell Healthcare Products LLC. 111 Wood Avenue South, Suite 210, Iselin, NJ 08830 USA Gammex PI Hybrid Surgical Glove (also marketed as Encore PI HybridSurgical Glove) (K 151694)
#### 4. Device Description:
The subject device is single-use disposable powder-free surgical glove that is supplied
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Fuqian Xi Road, West district of Shenze Industrial Base, Shenze County, Hebei Province, CHINA 050000
sterile and made of polyisoprene.
### 5. Intended for Use:
This surgeon's glove is a sterile and single use device intended to be worn on the hands of operating room personnel to protect a surgical wound from contamination.
#### 6. Technological Characteristics:
Sterile Polyisoprene Powder Free Surgical Gloves have the following technological characteristics as compared to ASTM or equivalent standards:
| Technological Characteristics | Standard/Test/FDA Guidance | Result Summary |
|-------------------------------------------------|----------------------------|---------------------------------------------------------------------------------------------------------------------------------|
| Dimensions | ASTM D3577-09(2015) | Meets ASTM D3577
requirements for length, width
and thickness |
| --Length | Minimum 265mm | Average 305mm |
| --Palm Width (size) | (mm) | Average value in mm |
| 5½ | 70ଖ | 73 |
| 6 | 76ଖ | 79 |
| 6½ | 83ଖ | 86 |
| 7 | 89ଖ | 91 |
| 7½ | 95ଖ | 97 |
| 8 | 102ଖ | 105 |
| 8½ | 108ଖ | 111 |
| 9 | 114ଖ | 117 |
| --Thickness | | Average value in mm |
| Finger | Minimum 0.10 | 0.22 |
| Palm | Minimum 0.10 | 0.20 |
| Cuff | Minimum 0.10 | 0.18 |
| Physical Properties | ASTM D3577-09(2015) | Meets ASTM D3577-09(2015)
requirements for tensile strength
and elongation at break before
and after accelerated aging |
| Tensile Strength, Before
Aging | 17MPa, min | Average 19.4MPa |
| Ultimate Elongation, Before
Aging | 650%, min | Average 823% |
| Stress at 500% Elongation | 7.0 MPa, max | Average 2.2MPa |
| Tensile Strength, After
Accelerated Aging | 12MPa, min | Average 17.1 MPa |
| Ultimate Elongation, After
Accelerated Aging | 490%, min | Average 748 % |
| Freedom from holes | ASTM D3577-09(2015) | Meets ASTM D3577-09 (2015) |
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Fuqian Xi Road, West district of Shenze Industrial Base,
| | ASTM D 5151-06(2015) | and ASTMD5151-06(2015)
requirements of AQL1.5 |
|-----------------------------------------|---------------------------------------------|-------------------------------------------------------------------|
| Powder-Free | ASTM D3577-09(2015)
ASTM D 6124-06(2011) | Meets Applicable requirement for
Powder Free; ≤ 2 mg per glove |
| Sterility | ANSI/AAMI/ISO 11137-1:2006 | Meets ANSI/AAMI/ISO 11137-
1:2006 requirement of 10-6 SAL |
| Biocompatibility | | |
| ISO Skin Irritation Study | ISO 10993-10:2010 | Under the conditions of the study,
not an irritant |
| ISO Maximization
Sensitization Study | ISO 10993-10:2010 | Under the conditions of the study,
not a sensitizer |
## 7. Substantial Equivalence:
| Substantial Equivalence Comparison Table | | | |
|------------------------------------------|---------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|
| | Predicate | Subject Device | Comparison |
| Device Class | Class I | Class I | Same |
| 510K | K151694 | K171047 | Same |
| Product Code | KGO | KGO | Same |
| Regulation Number | 21 CFR 878.4460 | 21 CFR 878.4460 | Same |
| Regulation Name | Surgeon's | Surgeon's | Same |
| Indications for Use | This glove is intended to
be worn by operating
room personnel to protect
a surgical wound from
contamination. | This surgeon's glove is a
sterile and single use device
intended to be worn on the
hands of operating room
personnel to protect a
surgical wound from
contamination | Same |
| Prescription | Over-The-Counter-Use | Over-The-Counter-Use | Same |
| Materials | Synthetic rubber blend of
polyisoprene and
neoprene | Synthetic polyisoprene
rubber | Different |
| Design | Single use | Single use | Same |
| Sterile | Sterile | Sterile | Same |
| Powder-free | Powder-free | Powder-free | Same |
| Hand specific | Hand specific | Hand specific | Same |
| Beaded cuff | Beaded cuff | Beaded cuff | Same |
| Color | White | Clear | Different |
| Sterilization Method | Radiation | Radiation | Same |
| Sterility Assurance Level
(SAL) | 10-6SAL | 10-6SAL | Same |
| Shelf Life | 3 years | 3 years | Same |
| Dimensions and physical | Meets ASTM D3577-
09/2015)requirements | Meets ASTM D3577-
09/2015)requirements | Same |
| properties | | | |
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| Freedom from holes | Meets ASTM D3577-
09(2015)requirements of | Meets ASTM D3577-
09(2015)requirements of | Same |
|--------------------|----------------------------------------------|----------------------------------------------|------|
|--------------------|----------------------------------------------|----------------------------------------------|------|
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Fuqian Xi Road, West district of Shenze Industrial Base, Shenze County, Hebei Province, CHINA 050000
| | AQL 1.5 | AQL 1.5 | |
|------------------|----------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------|--|
| Powder-Free | Meets Applicable
Definition for Powder
Free; ≤ 2 mg per glove | Meets Applicable
Definition for Powder
Free; ≤ 2 mg per glove | |
| Biocompatibility | "Under the conditions of
the study, not an irritant"
and "Under the
conditions of the study,
not a sensitizer" | "Under the conditions of
the study, not an irritant"
and "Under the conditions
of the study, not a
sensitizer" | |
The subject device is manufactured from Synthetic polyisoprene rubber with polyurethane polymer inner coating to aid donning. The predicate device is manufactured from Synthetic rubber blend of polyisoprene and neoprene with polyurethane polymer inner coating to aid donning. Though the materials of construction differ, the subject device's materials are functionally equivalent to those of the cited predicate.
The subject device meets the applicable requirements for surgeon's gloves with regard to dimensions and sizes, physical properties, freedom from holes, powder residues, and protein content as found in the following standards: ASTM D3577-09(2015), ASTM D5151-06(2015) and ASTM D6124-06(2011). The subject device passes biological reactivity testing for dermal sensitization and irritation, in accord with the ISO 10993 series of standards.
### 8. Performance Data
A clinical study was not conducted on the subject or predicate devices.
### 9. Conclusion:
Based on the performed nonclinical test results, the Sterile Polyisoprene Powder Free Surgical Gloves is as safe, as effective, and performs as well as or better than the legally marketed device identified as Gammex PI Hybrid Surgical Glove, which was previously cleared under K151694, Class I (21 CFR 878.4460, Product code KGO).
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**Source:** [https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K171047](https://fda.innolitics.com/submissions/HO/subpart-e%E2%80%94surgical-devices/KGO/K171047)
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