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Bacterial phlebitis is primarily caused by skin contamination. When a catheter is inserted into a vein, the potential exists for bacteria from the skin to enter the bloodstream and infect the site. The skin is a natural habitat for many bacteria, and even with careful antiseptic techniques, some bacteria may still be present. This can lead to localized inflammation and infection at the site of the catheter, resulting in phlebitis.

Factors such as air contamination, improper catheter placement, and drug abnormalities can contribute to other complications or infections but are not the primary drivers of bacterial phlebitis. Skin contamination is a direct and common route for bacteria to gain access to the vascular system during the insertion and maintenance of intravenous devices. Therefore, ensuring proper skin antisepsis before catheter placement is crucial in preventing bacterial phlebitis.