Knowledge, attitudes, and practices regarding occupational protection among nursing assistants: a cross-sectional survey with K-means clustering analysis

Background Nursing assistants are routinely exposed to occupational hazards; this exposure, coupled with insufficient awareness and inconsistent compliance with safety precautions, significantly increases their risk of infection. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding occupational protection among nursing assistants in China. Methods We conducted a cross-sectional study from October to November 2025. We recruited 505 nursing assistants from 20 general hospitals in Guangdong Province using a convenience sampling approach. Data were collected via a self-administered questionnaire consisting of two parts: a socio-demographic section and the Occupational Protection KAP Assessment Scale. To identify distinct KAP profiles and their associated factors, we first performed cluster analysis, followed by univariate analysis and multinomial logistic regression. Results We analyzed 503 valid questionnaires, yielding an effective response rate of 99.6%. The mean scores (±SD) for knowledge, attitudes, and practices dimensions were 13.78 ± 1.71, 65.90 ± 5.54, and 63.23 ± 8.80, respectively, with score rates of 91.9, 87.9, and 84.3%. Cluster analysis revealed four distinct KAP profiles: the Synergistic Group (47.3%), Weak KAP Group (10.1%), High-Knowledge–Low-Attitude–Weak-Practice Group (18.7%), and High-Knowledge–High-Attitude–Low-Practice Group (23.9%). Significant differences ( p < 0.05) were observed among the clusters in terms of healthcare institution type and possession of a professional qualification certificate. Conclusion Nursing assistants demonstrated good knowledge of occupational protection, but there was a notable gap in practical implementation. The four KAP types identified through cluster analysis showed high heterogeneity. Targeted interventions should be developed based on these distinct profiles, shifting the focus from individual training to the establishment of systematic and supportive organizational environments and management systems. This approach can provide an empirical basis for optimizing occupational health policies for nursing assistants in China.