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. 2025 Jul 9;25(1):1023.
doi: 10.1186/s12909-025-07620-x.

A competency-based framework for preventing blood-borne pathogen occupational exposures in medical students: literature review and Delphi study

Pingping Wang #  1 , Minhong Cai #  1 , Yu Lv  2 , Qian Xiang  3
Affiliations

A competency-based framework for preventing blood-borne pathogen occupational exposures in medical students: literature review and Delphi study

Pingping Wang et al. BMC Med Educ. .

Abstract

Background: Blood-borne pathogen occupational exposures pose significant hazard to medical students during clinical internships, with needlestick injuries being the primary transmission vector for blood-borne pathogens (hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Current prevention guidelines lack tailored frameworks for this vulnerable population.

Methods: A two-phase method was conducted: literature review and Delphi method. Phase one conducted a literature review across PubMed, Web of Science, Embase, and Cochrane Library (2000–2024). Data were extracted to form an initial framework. During phase two, a modified Delphi method was employed with a multidisciplinary expert panel across two rounds to refine the initial framework developed from the literature review. Consensus thresholds required ≥ 70% agreement on 5-point Likert scale.

Results: The literature review initially identified 1,477 records, with 200 articles retained after search and selection process. During the modified Delphi process, a multidisciplinary panel of 25 experts (71.4% initial response rate; 65.7% retention) iteratively refined prevention strategies. The finalized framework comprises 13 actionable elements, stratified across prevention tiers: primary prevention (7 items), secondary prevention (4 items), and tertiary prevention (2 items).

Conclusion: This study provides the first competency-based framework for medical students to prevent blood-borne pathogen occupational exposures during clinical internships. The framework, informed by evidence-based strategies in conjunction with expert consensus, is a significant step forward in ensuring the occupational safety of medical students.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12909-025-07620-x.

Keywords: Blood-borne pathogen; Clinical internships; Delphi method; Medical students; Occupational exposure; Prevention framework.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ). This study was approved by the ethics committee of Sichuan Provincial People’s Hospital (approval no.309 of 2025). All participants provided written informed consent, and measures were taken to ensure confidentiality and anonymity of the data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Flowchart of search and selection process Flowchart illustrating the systematic process for literature search and study selection. A total of 1,477 records were initially identified, and after screening, 200 articles were deemed suitable for further analysis or inclusion in a study
Fig. 2
Fig. 2
Framework for preventing blood-borne pathogen occupational exposures A competency-based framework outlining evidence-based strategies to minimize the risk of blood-borne pathogen occupational exposures for medical students during clinical internships, comprised 13 actionable elements, stratified across prevention tiers: primary prevention (7 items), secondary prevention (4 items), and tertiary prevention (2 items)
Fig. 3
Fig. 3
Alignment between the framework and the NIOSH hierarchy of controls The selected framework components demonstrate alignment with four key dimensions of the NIOSH hierarchy of controls: substitution (replace the hazard), engineering controls (isolate from the hazard), administrative controls (change the way of working), and PPE (personal protective equipment)
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