The main university hospital in Iasi, Romania. To assess whether health care workers (HCWs) have a higher risk of acquiring tuberculosis (TB) than the general population, and if TB incidence varies between departments, to develop adequate infection control measures. All records of TB cases among HCWs were reviewed by cross-checking laboratory and medical records (retrospectively, 1971--1996; prospectively 1997--2003, following the implementation of the first World Health Organization pilot project in Romania). Annual TB incidence rates among HCWs were calculated and compared with those of the general population; relative and attributable risk with 95% confidence intervals (CI) were calculated. Fifty TB cases were diagnosed in HCWs; 42% were nurses, 24% ancillary staff, 12% physicians, 10% laboratory staff, 10% administrative staff and 2% radiology technicians. The mean incidence of TB in Romania during the study period was 96.8 per 100,000 persons/year (95%CI 83.5-110.1); the mean incidence among HCWs was 942.8/100,000 persons/year (95%CI 726.3-1159.3, P < 0.001); comparing the two previous absolute risks, the mean relative risk was 11 (95%CI 8-14) and the attributable risk 846. TB is a major occupational hazard in Iasi, Romania, where a great potential exists for further development of an effective infection control plan.