Evaluation of novel disinfection methods for the remediation of heavily contaminated thermostatic mixing valves and water systems with Pseudomonas aeruginosa biofilm: considerations for new and existing healthcare water systems.

In-line thermal flushing was the most effective method to remove P. aeruginosa biofilm. Results vary significantly with the strain of bacteria and the composition of the plumbing. Several methods used in combination may be necessary to remove established biofilm.