Background <p>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.</p> Methods <p>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.</p> Results <p>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).</p> Conclusion <p>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.</p>