Knowledge, attitudes, and practices regarding transfusion-related acute lung injury among healthcare providers in Jiangsu: a multicenter cross-sectional study

Abstract This cross-sectional survey evaluated the knowledge, attitudes, and practices (KAP) of healthcare providers regarding transfusion-related acute lung injury (TRALI) in Jiangsu from March to May 2025. A self-administered questionnaire was distributed, with 746 valid responses analyzed. Respondents were predominantly female (76.5%), employed in tertiary hospitals (88.2%), and held a bachelor’s degree or lower (81.6%), with nurses comprising 67.3% of participants. Only 34.5% had received formal TRALI-related training in the past three years. Knowledge, attitude, and practice scores were 22.49 ± 2.38 (0–24), 43.62 ± 3.37 (10–50), and 50.27 ± 7.13 (11–55), respectively. Path analysis indicated that knowledge exerted a significant direct positive effect on attitude (β = 0.337, P = 0.009) and practice (β = 0.136, P = 0.011), with an indirect effect on practice mediated by attitude (β = 0.179, P = 0.008). Attitude had the strongest direct influence on practice (β = 0.532, P = 0.014). The findings suggest that healthcare providers demonstrated relatively high overall knowledge and practice scores; however, notable gaps remained, particularly in treatment-related knowledge and proactive practices, with attitudes notably mediating the translation of knowledge into practice. To strengthen TRALI prevention and management, targeted, regularly updated training and institution-wide protocols are recommended to reinforce awareness, optimize attitudes, and sustain best practices.