*(c) Contamination adjacent to the site of insertion and extraluminal surface skin.*

Access to microorganisms from the skin adjacent the insertion site of the catheter is the most common for colonization and subsequent infection-related pathogenic mechanism. This is the only way for a microorganism to get into the bloodstream in the first 8 days (in the absence of product contamination infusion). Microorganisms on the skin through the insertion point enter the extraluminal surface of catheters and form the biofilm at that level to the intravascular end.

Another option of extraluminal contamination of a vascular catheter colonization can be by hematogenous spread of a microorganism originated in a distant focus, which is very rare, observed mainly in critically ill patients with long-term catheters or in patients with intestinal diseases [19].
