Which is NOT a way pathogens are spread through direct contact?

The correct choice reflects that sneezing is not a form of direct contact transmission. While sneezing does facilitate the spread of pathogens, it primarily does so through the air. This action releases respiratory droplets that can carry viruses and bacteria, allowing for aerosol transmission rather than direct contact transmission.

In contrast, touching infected surfaces, skin-to-skin contact, and biting all involve physical interaction between individuals or between a person and a contaminated object. Touching infected surfaces can lead to transmission if an individual subsequently touches their face, while skin-to-skin contact can directly transfer pathogens from one person to another. Biting can also introduce pathogens directly into the bloodstream or mucous membranes of another person. Therefore, sneezing stands out as a mechanism of transmission that is mediated by air and droplets rather than through direct physical contact.