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Luer connectors are used in medical devices with a wide range of functions, raising the possibility of accidental cross connection between devices. We assessed the hazards arising from accidental misconnection, and reviewed adverse incidents known to have involved Luer connectors. We considered three possible strategies for reducing the risk of misconnection being made: 1) The use of different male/female sequences for different applications. 2) The use of colour coding. 3) The restriction of the applications for which the use of Luer connectors is permitted. Only the last of these offered real benefits.