To the Editor—Pathogens can contaminate the environment and cause infections. In hospitals, contamination of the environment is frequent and expected. Toilets in hospitals are an area of concern. The high contamination rates of toilet tap handles or levers for manual flushing are reported in many publications.Reference Casey, Adams and Karpanen ^{1 ,} Reference Bellamy, Laban, Barrett and Talbot ² Toilet seats and handles are commonly found to be contaminated.Reference Casey, Adams and Karpanen ¹ A good “toilet design” is proposed that could help control the spread of nosocomial infection.Reference Breathnach, Cubbon, Karunaharan, Pope and Planche ³ To reduce the problem of contamination, toilets with hands-free automatic flushing mechanisms or water taps have been available for a few years. Here, the authors report a field survey of 180 toilets from 25 hospitals in Bangkok, Thailand. According to the survey, automatic hands-free flushing mechanisms were available in 65 toilets (36.1%). Most of the toilets studied lacked automatic water taps and classic toilet tap handles are still in use. The findings are potentially important and not just of local interest. Numerous hospitals in many countries in the world may still use manual flushing mechanisms. Promotion of the automatic water tap in hospitals will help improve hand hygiene in healthcare workers, visitors, and patients and may help reduce the problem of possible pathogen transmission.